Compressible adjuncts with bonding nodes

ABSTRACT

A staple cartridge assembly is used with a surgical stapler. The staple cartridge assembly includes a staple cartridge including a cartridge body, a cartridge deck, and a plurality of staples deployable from the cartridge body through the cartridge deck. The staple cartridge assembly includes a compressible adjunct positionable against the cartridge deck. The compressible adjunct includes a plurality of unaltered fibers and a plurality of altered fibers that are melted and resolidified. The unaltered fibers include a first fiber including a first fiber portion and a second fiber including a second fiber portion extending over the first fiber portion. The compressible adjunct further includes a node which comprises the first fiber portion, the second fiber portion, and at least a portion of the plurality of altered fibers, wherein the at least a portion of the plurality of altered fibers affixes the first fiber portion and the second fiber portion.

BACKGROUND

The present invention relates to surgical instruments and, in variousarrangements, to surgical stapling and cutting instruments and staplecartridges for use therewith that are designed to staple and cut tissue.

BRIEF DESCRIPTION OF THE DRAWINGS

The features of the various embodiments are set forth with particularityin the appended claims. The various embodiments, however, both as toorganization and methods of operation, together with advantages thereof,may best be understood by reference to the following description, takenin conjunction with the accompanying drawings as follows:

FIG. 1 is a perspective view of a surgical stapling and severinginstrument comprising a handle, a shaft extending from the handle, andan end effector extending including an anvil and a staple cartridge;

FIG. 2 is a perspective view of a wedge sled of a staple cartridge ofthe surgical stapling and severing instrument of FIG. 1;

FIG. 3 is a perspective view of a two-piece knife and firing bar(“E-beam”) of the surgical stapling and severing instrument of FIG. 1;

FIG. 4 is a longitudinal cross-sectional view of an anvil in a closedposition, a staple cartridge comprising a rigid support portion, and acompressible adjunct illustrated with staples being moved from anunfired position to a fired position during a firing sequence;

FIG. 5 is another cross-sectional view of the anvil and the staplecartridge of FIG. 4 illustrating the anvil in an open position after thefiring sequence has been completed;

FIG. 6 is a side view of a compressible adjunct and a staple cartridgein accordance with at least one embodiment;

FIG. 7 is a transverse cross-sectional view of a staple cartridgeassembly including a staple cartridge and a compressible layer, whereina portion of the compressible adjunct has been removed for the purposeof illustration;

FIG. 8 is a partial perspective view of an end effector including astaple cartridge, a compressible layer, and a bonding layer, wherein aportion of the compressible layer has been removed for the purpose ofillustration;

FIG. 9 is a transverse cross-sectional view of a compressible adjunctassembly attached to an anvil of a surgical instrument;

FIG. 10 is a transverse cross-sectional view of a compressible adjunctassembly attached to an anvil of a surgical instrument;

FIG. 11 is a transverse cross-sectional view of a compressible adjunctassembly attached to an anvil of a surgical instrument;

FIG. 12 a partial perspective view of an anvil assembled with anattachment layer, wherein a portion of the anvil has been removed forthe purpose of illustration;

FIG. 13 is a perspective view of the attachment layer of FIG. 12;

FIG. 14 is a partial perspective view of tissue sandwiched between twocompressible adjunct assemblies, wherein the tissue is stapled and cutusing a surgical stapling and severing instrument according to at leastone embodiment disclosed herein;

FIG. 15 is a transverse cross-sectional view of the tissue andcompressible adjunct assemblies of FIG. 14;

FIG. 16 is a perspective view of an attachment layer including anintermediate section having a bar extending therefrom;

FIG. 17 is a transverse cross-sectional view of an anvil assembled witha compressible adjunct assembly including an attachment layer and acompressible layer;

FIG. 18 is a partial perspective view of a compressible adjunct assemblyincluding a compressible layer and two attachment members in accordancewith at least one embodiment described herein;

FIG. 19 is a cross-sectional view of an anvil assembled with thecompressible adjunct assembly of FIG. 18 after the compressible adjunctassembly has been severed by a cutting edge;

FIG. 20 is a partial perspective view of a compressible adjunct assemblyincluding a compressible layer and two attachment members in accordancewith at least one embodiment described herein;

FIG. 21 is a perspective view of a compressible adjunct assemblyincluding a compressible layer and two attachment members in accordancewith at least one embodiment described herein;

FIG. 22 is a partial perspective view of a compressible adjunct assemblyincluding a compressible layer and a plurality of attachment members inaccordance with at least one embodiment described herein;

FIG. 23 is a transverse cross-sectional view of an anvil assembled withthe compressible adjunct assembly of FIG. 22;

FIG. 24 is a partial longitudinal cross-sectional view of thecompressible adjunct assembly of FIG. 22;

FIG. 25 is a partial perspective view of a compressible adjunct assemblyincluding a compressible layer and a plurality of attachment members inaccordance with at least one embodiment described herein;

FIG. 26 is a partial longitudinal cross-sectional view of an attachmentmember attached to a compressible layer in accordance with at least oneembodiment described herein;

FIG. 27 is a partial longitudinal cross-sectional view of an attachmentmember attached to a compressible layer in accordance with at least oneembodiment described herein;

FIG. 28 is a partial longitudinal cross-sectional view of an attachmentmember attached to a compressible layer in accordance with at least oneembodiment described herein;

FIG. 29 is a partial perspective view of an anvil assembled with twoattachment layers in accordance with at least one embodiment describedherein;

FIG. 30 is a perspective view of attachment members of the attachmentlayers of FIG. 29;

FIG. 31 is a partial perspective view of a distal portion of theattachment layers of FIG. 29;

FIG. 32 is another partial perspective view of the distal portion of theattachment layers of FIG. 29;

FIG. 33 is a partial longitudinal cross-sectional view of the attachmentlayers of FIG. 29;

FIG. 34 is another partial perspective view of the distal portion of theattachment layers of FIG. 29;

FIG. 35 is a partial cross-sectional view of a staple cartridge assemblycomprising an implantable adjunct in an attached configuration inaccordance with at least one embodiment;

FIG. 36 is a partial cross-sectional view of the staple cartridgeassembly of FIG. 35 where the implantable adjunct is in a detachedconfiguration;

FIG. 37 is a partial side view of a surgical stapling assemblycomprising a staple cartridge, a plurality of staples, and animplantable adjunct where the surgical stapling assembly has beenpartially fired and a portion of the implantable adjunct has beenseparated from the staple cartridge;

FIG. 38 is a partial cross-sectional view of the surgical staplingassembly of FIG. 37 illustrating a staple that has not been deployedfrom the staple cartridge;

FIG. 39 is a partial side view of a surgical stapling assemblycomprising a staple cartridge, a plurality of barbed staples, and animplantable adjunct where the surgical stapling assembly has beenpartially fired and a portion of the implantable adjunct has beenseparated from the staple cartridge;

FIG. 40 is a partial cross-sectional view of the surgical staplingassembly of FIG. 39 illustrating a staple that has not been deployedfrom the staple cartridge;

FIG. 41 is partial perspective view of a staple cartridge assemblycomprising a staple cartridge and an implantable adjunct residing atleast partially within the staple cartridge in accordance with at leastone embodiment;

FIG. 42 is a partial, end perspective view of a staple cartridgeassembly comprising a staple cartridge and an implantable adjunctcomprising a body portion and a plurality of attachment portions inaccordance with at least one embodiment;

FIG. 43 is a perspective view of a sled of a firing assembly inaccordance with at least one embodiment;

FIG. 44 is a partial side view of a surgical stapling assemblycomprising the staple cartridge assembly of FIG. 42 which includes astaple cartridge and an implantable adjunct and a firing assemblycomprising the sled of FIG. 43 where the surgical stapling assembly hasbeen partially fired and a portion of the implantable adjunct has beendetached from the staple cartridge;

FIG. 45 is a partial, end perspective view of a staple cartridgeassembly comprising deck retaining features in accordance with at leastone embodiment;

FIG. 46 illustrates an initial step of a method for assembling animplantable adjunct onto a staple cartridge;

FIG. 47 illustrates another step in the method depicted in FIG. 46;

FIG. 48 illustrates a subsequent step in the method depicted in FIGS. 46and 47;

FIG. 49 is a detail view of a staple cartridge assembly in accordancewith at least one embodiment comprising an implantable layer;

FIG. 50 is a detail view of the layer of FIG. 49 implanted against thetissue of a patient;

FIG. 51 is a perspective view of an implantable layer assembly inaccordance with at least one embodiment;

FIG. 52 illustrates a fiber assembly including a first fiber comprisedof a first material intertwined with a second fiber comprised of asecond material;

FIG. 53 illustrates the fiber assembly of FIG. 52 being exposed to heat;

FIG. 54 illustrates the fiber assembly of FIG. 52 in a contracted stateafter being exposed to the heat;

FIG. 55 is a perspective view of an implantable layer in accordance withat least one embodiment;

FIG. 56 is a perspective view of the layer of FIG. 55 in a contractedstate after being exposed to heat;

FIG. 57 is a perspective view of a staple cartridge assembly inaccordance with at least one embodiment comprising an implantable layer;

FIG. 58 is a cross-sectional view of a staple cartridge assembly inaccordance with at least one embodiment comprising staples havingdifferent unformed heights;

FIG. 59 illustrates the staples of FIG. 58 formed to different formedheights;

FIG. 60 illustrates a plurality of kinked fibers in accordance with atleast one embodiment;

FIG. 61 is a perspective view of a kinked fiber of FIG. 60;

FIG. 62 is a partial perspective view of an implantable layer that doesnot comprise kinked fibers;

FIG. 63 is a partial perspective view of an implantable layer inaccordance with at least one embodiment that comprises the kinked fibersof FIG. 60;

FIG. 64 is a perspective view of an implantable layer in accordance withat least one embodiment that comprises the kinked fibers of FIG. 60;

FIG. 65 illustrates a process for creating the kinked fibers of FIG. 60;

FIG. 66 illustrates a process for creating the kinked fibers of FIG. 60;

FIG. 67 illustrates a process for creating the kinked fibers of FIG. 60;

FIG. 68 is a perspective view of an implantable layer in accordance withat least one embodiment comprising the kinked fibers of FIG. 60interwoven with another group of fibers;

FIG. 69 is a detail view of the implantable layer of FIG. 68;

FIG. 70 is another detail view of the implantable layer of FIG. 68;

FIG. 71 is a cross-sectional view of a staple cartridge assembly inaccordance with at least one embodiment including an implantable layer;

FIG. 72 is a cross-sectional view of the implantable layer of FIG. 71;

FIG. 73 is a cross-sectional view of an implantable layer in accordancewith at least one alternative embodiment;

FIG. 74 is a cross-sectional view of an implantable layer in accordancewith at least one alternative embodiment;

FIG. 75 is a cross-sectional view of an implantable layer in accordancewith at least one embodiment;

FIG. 76 is a cross-sectional view of the implantable layer of FIG. 75;

FIG. 77 is a cross-sectional view of an implantable layer in accordancewith at least one embodiment;

FIG. 78 is a perspective view of an implantable layer assembly inaccordance with at least one embodiment;

FIG. 79 is an exploded view of the implantable layer assembly of FIG.78;

FIG. 80 is a partial cross-sectional view of an implantable layer inaccordance with at least one embodiment;

FIG. 81 is a detail view of a portion of the implantable layer of FIG.80;

FIG. 82 is a plan view of a portion of the implantable layer assembly ofFIG. 78;

FIG. 83 illustrates the implantable layer portion of FIG. 82 in astretched condition;

FIG. 84 is a plan view of a portion of the implantable layer assembly ofFIG. 78;

FIG. 85 illustrates the implantable layer portion of FIG. 84 in astretched condition;

FIG. 86 is a plan view of an implantable layer in accordance with atleast one alternative embodiment;

FIG. 87 is a plan view of an implantable layer in accordance with atleast one alternative embodiment;

FIG. 88 is a plan view of an implantable layer in accordance with atleast one alternative embodiment;

FIGS. 89A-89C illustrate manufacturing processes for creating openingsin an implantable layer in accordance with at least one embodiment;

FIG. 90 is a partial cross-sectional view of an implantable layer inaccordance with at least one embodiment;

FIG. 91 is a partial perspective view of an implantable layer inaccordance with at least one embodiment;

FIG. 92 is a partial cross-sectional view of the implantable layer ofFIG. 91;

FIG. 93 is a perspective view of a partially-assembled compressibleadjunct assembly including a plurality of fibrous tubular members;

FIG. 94 is a partial perspective view of the compressible adjunctassembly of FIG. 93 assembled and thermally treated in accordance withat least one embodiment described herein;

FIG. 95 is a partial perspective view of a compressible adjunct assemblybeing inserted into a heated mold in accordance with at least oneembodiment described herein;

FIG. 96 is a cross-sectional view of the compressible adjunct assemblyof FIG. 95 being subjected to a thermal pressing treatment in accordancewith at least one embodiment described herein;

FIG. 97 is a partial perspective view of the compressible adjunctassembly of FIG. 95 after the thermal treatment is completed and afterremoval from the mold;

FIG. 98 is perspective view of a compressible adjunct assembly assembledwith a staple cartridge in accordance with at least one embodimentdescribed herein;

FIG. 99 is front view of the compressible adjunct assembly of FIG. 98,wherein a portion of the compressible adjunct assembly has been removedfor the purpose of illustration;

FIG. 100 is a close-up of an internal portion of the compressibleadjunct assembly of FIG. 99;

FIG. 101 is an illustration of a first plurality fibers and a secondplurality of fibers, wherein the second plurality of fibers is meltedand resolidified in accordance with at least one embodiment describedherein;

FIG. 102 is an illustration of a compressible adjunct assembly inaccordance with at least one embodiment described herein;

FIG. 103 is a cross-sectional view of the compressible adjunct assemblyof FIG. 102 being subjected to a thermal pressing treatment inaccordance with at least one embodiment described herein;

FIG. 104 is a partial cross-sectional view of a compressible adjunctassembly, wherein a portion of the compressible adjunct assembly hasbeen removed for the purpose of illustration;

FIG. 105 is a partial cross-sectional view of a compressible adjunctassembly in accordance with at least one embodiment described herein;

FIG. 106 is a partial cross-sectional view of a compressible adjunctassembly in accordance with at least one embodiment described herein;and

FIG. 107 is a partial cross-sectional view of a compressible adjunctassembly in accordance with at least one embodiment described herein.

Corresponding reference characters indicate corresponding partsthroughout the several views. The exemplifications set out hereinillustrate various embodiments of the invention, in one form, and suchexemplifications are not to be construed as limiting the scope of theinvention in any manner.

DETAILED DESCRIPTION

The Applicant of the present application owns the following U.S. PatentApplications that were filed on Sep. 30, 2015 and which are each hereinincorporated by reference in their respective entireties:

U.S. patent application Ser. No. 14/871,036, entitled IMPLANTABLE LAYERCOMPRISING PLASTICALLY DEFORMED FIBERS; now U.S. Patent ApplicationPublication No. 2017/0086835;

U.S. patent application Ser. No. 14/871,056, entitled IMPLANTABLE LAYERCOMPRISING A CONSTRICTED CONFIGURATION; now U.S. Patent ApplicationPublication No. 2017/0086836;

U.S. patent application Ser. No. 14/871,078, entitled TUBULAR ABSORBABLECONSTRUCTS; now U.S. Patent Application Publication No. 2017/0086832;

U.S. patent application Ser. No. 14/871,087, entitled IMPLANTABLEADJUNCT COMPRISING BONDED LAYERS; now U.S. Patent ApplicationPublication No. 2017/0086838;

U.S. patent application Ser. No. 14/871,057, entitled COMPRESSIBLEADJUNCT WITH INTERMEDIATE SUPPORTING STRUCTURES; now U.S. PatentApplication Publication No. 2017/0086829;

U.S. patent application Ser. No. 14/871,071, entitled COMPRESSIBLEADJUNCT WITH CROSSING SPACER FIBERS; now U.S. Patent ApplicationPublication No. 2017/0086837;

U.S. patent application Ser. No. 14/871,083, entitled COMPRESSIBLEADJUNCT WITH LOOPING MEMBERS; Patent Application Publication No.2017/0086827;

U.S. patent application Ser. No. 14/871,089, entitled WOVEN CONSTRUCTSWITH INTERLOCKED STANDING FIBERS; now U.S. Patent ApplicationPublication No. 2017/0086839;

U.S. patent application Ser. No. 14/871,119, entitled COMPRESSIBLEADJUNCT AND METHODS FOR MAKING THE SAME; now U.S. Patent ApplicationPublication No. 2017/0086841;

U.S. patent application Ser. No. 14/871,131, entitled METHOD FORAPPLYING AN IMPLANTABLE LAYER TO A FASTENER CARTRIDGE; now U.S. PatentApplication Publication No. 2017/0086842;

U.S. patent application Ser. No. 14/871,153, entitled COMPRESSIBLEADJUNCT WITH ATTACHMENT REGIONS; now U.S. Patent Application PublicationNo. 2017/0086843;

U.S. patent application Ser. No. 14/871,176, entitled PROGRESSIVELYRELEASABLE IMPLANTABLE ADJUNCT FOR USE WITH A SURGICAL STAPLINGINSTRUMENT; now U.S. Patent Application Publication No. 2017/0086844;and

U.S. patent application Ser. No. 14/871,195, entitled COMPRESSIBLEADJUNCT ASSEMBLIES WITH ATTACHMENT LAYERS; now U.S. Patent ApplicationPublication No. 2017/0086845.

The Applicant of the present application also owns the U.S. PatentApplications identified below which are each herein incorporated byreference in their respective entireties:

U.S. patent application Ser. No. 12/894,311, entitled SURGICALINSTRUMENTS WITH RECONFIGURABLE SHAFT SEGMENTS; now U.S. Pat. No.8,763,877;

U.S. patent application Ser. No. 12/894,340, entitled SURGICAL STAPLECARTRIDGES SUPPORTING NON-LINEARLY ARRANGED STAPLES AND SURGICALSTAPLING INSTRUMENTS WITH COMMON STAPLE-FORMING POCKETS; now U.S. Pat.No. 8,899,463;

U.S. patent application Ser. No. 12/894,327, entitled JAW CLOSUREARRANGEMENTS FOR SURGICAL INSTRUMENTS; now U.S. Pat. No. 8,978,956;

U.S. patent application Ser. No. 12/894,351, entitled SURGICAL CUTTINGAND FASTENING INSTRUMENTS WITH SEPARATE AND DISTINCT FASTENER DEPLOYMENTAND TISSUE CUTTING SYSTEMS; now U.S. Pat. No. 9,113,864;

U.S. patent application Ser. No. 12/894,338, entitled IMPLANTABLEFASTENER CARTRIDGE HAVING A NON-UNIFORM ARRANGEMENT; now U.S. Pat. No.8,864,007;

U.S. patent application Ser. No. 12/894,369, entitled IMPLANTABLEFASTENER CARTRIDGE COMPRISING A SUPPORT RETAINER; now U.S. PatentApplication Publication No. 2012/0080344;

U.S. patent application Ser. No. 12/894,312, entitled IMPLANTABLEFASTENER CARTRIDGE COMPRISING MULTIPLE LAYERS; now U.S. Pat. No.8,925,782;

U.S. patent application Ser. No. 12/894,377, entitled SELECTIVELYORIENTABLE IMPLANTABLE FASTENER CARTRIDGE; now U.S. Pat. No. 8,393,514;

U.S. patent application Ser. No. 12/894,339, entitled SURGICAL STAPLINGINSTRUMENT WITH COMPACT ARTICULATION CONTROL ARRANGEMENT; now U.S. Pat.No. 8,840,003;

U.S. patent application Ser. No. 12/894,360, entitled SURGICAL STAPLINGINSTRUMENT WITH A VARIABLE STAPLE FORMING SYSTEM; now U.S. Pat. No.9,113,862;

U.S. patent application Ser. No. 12/894,322, entitled SURGICAL STAPLINGINSTRUMENT WITH INTERCHANGEABLE STAPLE CARTRIDGE ARRANGEMENTS; now U.S.Pat. No. 8,740,034;

U.S. patent application Ser. No. 12/894,350, entitled SURGICAL STAPLECARTRIDGES WITH DETACHABLE SUPPORT STRUCTURES; now U.S. PatentApplication Publication No. 2012/0080478;

U.S. patent application Ser. No. 12/894,383, entitled IMPLANTABLEFASTENER CARTRIDGE COMPRISING BIOABSORBABLE LAYERS; now U.S. Pat. No.8,752,699;

U.S. patent application Ser. No. 12/894,389, entitled COMPRESSIBLEFASTENER CARTRIDGE; now U.S. Pat. No. 8,740,037;

U.S. patent application Ser. No. 12/894,345, entitled FASTENERSSUPPORTED BY A FASTENER CARTRIDGE SUPPORT; now U.S. Pat. No. 8,783,542;

U.S. patent application Ser. No. 12/894,306, entitled COLLAPSIBLEFASTENER CARTRIDGE; now U.S. Pat. No. 9,044,227;

U.S. patent application Ser. No. 12/894,318, entitled FASTENER SYSTEMCOMPRISING A PLURALITY OF CONNECTED RETENTION MATRIX ELEMENTS; now U.S.Pat. No. 8,814,024;

U.S. patent application Ser. No. 12/894,330, entitled FASTENER SYSTEMCOMPRISING A RETENTION MATRIX AND AN ALIGNMENT MATRIX; now U.S. Pat. No.8,757,465;

U.S. patent application Ser. No. 12/894,361, entitled FASTENER SYSTEMCOMPRISING A RETENTION MATRIX; now U.S. Pat. No. 8,529,600;

U.S. patent application Ser. No. 12/894,367, entitled FASTENINGINSTRUMENT FOR DEPLOYING A FASTENER SYSTEM COMPRISING A RETENTIONMATRIX; now U.S. Pat. No. 9,033,203;

U.S. patent application Ser. No. 12/894,388, entitled FASTENER SYSTEMCOMPRISING A RETENTION MATRIX AND A COVER; now U.S. Pat. No. 8,474,677;

U.S. patent application Ser. No. 12/894,376, entitled FASTENER SYSTEMCOMPRISING A PLURALITY OF FASTENER CARTRIDGES; now U.S. Pat. No.9,044,228;

U.S. patent application Ser. No. 13/097,865, entitled SURGICAL STAPLERANVIL COMPRISING A PLURALITY OF FORMING POCKETS; now U.S. PatentApplication Publication No. 2012/0080488;

U.S. patent application Ser. No. 13/097,936, entitled TISSUE THICKNESSCOMPENSATOR FOR A SURGICAL STAPLER; now U.S. Pat. No. 8,657,176;

U.S. patent application Ser. No. 13/097,954, entitled STAPLE CARTRIDGECOMPRISING A VARIABLE THICKNESS COMPRESSIBLE PORTION; now U.S. PatentApplication Publication No. 2012/0080340;

U.S. patent application Ser. No. 13/097,856, entitled STAPLE CARTRIDGECOMPRISING STAPLES POSITIONED WITHIN A COMPRESSIBLE PORTION THEREOF; nowU.S. Patent Application Publication No. 2012/0080336;

U.S. patent application Ser. No. 13/097,928, entitled TISSUE THICKNESSCOMPENSATOR COMPRISING DETACHABLE PORTIONS; now U.S. Pat. No. 8,746,535;

U.S. patent application Ser. No. 13/097,891, entitled TISSUE THICKNESSCOMPENSATOR FOR A SURGICAL STAPLER COMPRISING AN ADJUSTABLE ANVIL; nowU.S. Pat. No. 8,864,009;

U.S. patent application Ser. No. 13/097,948, entitled STAPLE CARTRIDGECOMPRISING AN ADJUSTABLE DISTAL PORTION; now U.S. Pat. No. 8,978,954;

U.S. patent application Ser. No. 13/097,907, entitled COMPRESSIBLESTAPLE CARTRIDGE ASSEMBLY; now U.S. Patent Application Publication No.2012/0080338;

U.S. patent application Ser. No. 13/097,861, entitled TISSUE THICKNESSCOMPENSATOR COMPRISING PORTIONS HAVING DIFFERENT PROPERTIES; now U.S.Pat. No. 9,113,865;

U.S. patent application Ser. No. 13/097,869, entitled STAPLE CARTRIDGELOADING ASSEMBLY; now U.S. Pat. No. 8,857,694;

U.S. patent application Ser. No. 13/097,917, entitled COMPRESSIBLESTAPLE CARTRIDGE COMPRISING ALIGNMENT MEMBERS; now U.S. Pat. No.8,777,004;

U.S. patent application Ser. No. 13/097,873, entitled STAPLE CARTRIDGECOMPRISING A RELEASABLE PORTION; now U.S. Pat. No. 8,740,038;

U.S. patent application Ser. No. 13/097,938, entitled STAPLE CARTRIDGECOMPRISING COMPRESSIBLE DISTORTION RESISTANT COMPONENTS; now U.S. Pat.No. 9,016,542;

U.S. patent application Ser. No. 13/097,924, entitled STAPLE CARTRIDGECOMPRISING A TISSUE THICKNESS COMPENSATOR; now U.S. Patent ApplicationPublication No. 2012/0083835;

U.S. patent application Ser. No. 13/242,029, entitled SURGICAL STAPLERWITH FLOATING ANVIL; now U.S. Pat. No. 8,893,949;

U.S. patent application Ser. No. 13/242,066, entitled CURVED ENDEFFECTOR FOR A STAPLING INSTRUMENT; now U.S. Patent ApplicationPublication No. 2012/0080498;

U.S. patent application Ser. No. 13/242,086, entitled STAPLE CARTRIDGEINCLUDING COLLAPSIBLE DECK; now U.S. Pat. No. 9,055,941;

U.S. patent application Ser. No. 13/241,912, entitled STAPLE CARTRIDGEINCLUDING COLLAPSIBLE DECK ARRANGEMENT; now U.S. Pat. No. 9,050,084;

U.S. patent application Ser. No. 13/241,922, entitled SURGICAL STAPLERWITH STATIONARY STAPLE DRIVERS; now U.S. Patent Application PublicationNo. 2013/0075449;

U.S. patent application Ser. No. 13/241,637, entitled SURGICALINSTRUMENT WITH TRIGGER ASSEMBLY FOR GENERATING MULTIPLE ACTUATIONMOTIONS; now U.S. Pat. No. 8,789,741;

U.S. patent application Ser. No. 13/241,629, entitled SURGICALINSTRUMENT WITH SELECTIVELY ARTICULATABLE END EFFECTOR; now U.S. PatentApplication Publication No. 2012/0074200;

U.S. patent application Ser. No. 13/433,096, entitled TISSUE THICKNESSCOMPENSATOR COMPRISING A PLURALITY OF CAPSULES; now U.S. PatentApplication Publication No. 2012/0241496;

U.S. patent application Ser. No. 13/433,103, entitled TISSUE THICKNESSCOMPENSATOR COMPRISING A PLURALITY OF LAYERS; now U.S. PatentApplication Publication No. 2012/0241498;

U.S. patent application Ser. No. 13/433,098, entitled EXPANDABLE TISSUETHICKNESS COMPENSATOR; now U.S. Patent Application Publication No.2012/0241491;

U.S. patent application Ser. No. 13/433,102, entitled TISSUE THICKNESSCOMPENSATOR COMPRISING A RESERVOIR; now U.S. Patent ApplicationPublication No. 2012/0241497;

U.S. patent application Ser. No. 13/433,114, entitled RETAINER ASSEMBLYINCLUDING A TISSUE THICKNESS COMPENSATOR; now U.S. Patent ApplicationPublication No. 2012/0241499;

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U.S. patent application Ser. No. 13/433,144, entitled TISSUE THICKNESSCOMPENSATOR COMPRISING FIBERS TO PRODUCE A RESILIENT LOAD; now U.S.Patent Application Publication No. 2012/0241500;

U.S. patent application Ser. No. 13/433,148, entitled TISSUE THICKNESSCOMPENSATOR COMPRISING STRUCTURE TO PRODUCE A RESILIENT LOAD; now U.S.Patent Application Publication No. 2012/0241501;

U.S. patent application Ser. No. 13/433,155, entitled TISSUE THICKNESSCOMPENSATOR COMPRISING RESILIENT MEMBERS; now U.S. Patent ApplicationPublication No. 2012/0241502;

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U.S. patent application Ser. No. 11/714,049, entitled SURGICAL STAPLINGDEVICE WITH ANVIL HAVING STAPLE FORMING POCKETS OF VARYING DEPTHS, nowU.S. Patent Application Publication No. 2007/0194082;

U.S. patent application Ser. No. 11/711,979, entitled SURGICAL STAPLINGDEVICES THAT PRODUCE FORMED STAPLES HAVING DIFFERENT LENGTHS, now U.S.Pat. No. 8,317,070;

U.S. patent application Ser. No. 11/711,975, entitled SURGICAL STAPLINGDEVICE WITH STAPLE DRIVERS OF DIFFERENT HEIGHT, now U.S. PatentApplication Publication No. 2007/0194079;

U.S. patent application Ser. No. 11/711,977, entitled SURGICAL STAPLINGDEVICE WITH STAPLE DRIVER THAT SUPPORTS MULTIPLE WIRE DIAMETER STAPLES,now U.S. Pat. No. 7,673,781;

U.S. patent application Ser. No. 11/712,315, entitled SURGICAL STAPLINGDEVICE WITH MULTIPLE STACKED ACTUATOR WEDGE CAMS FOR DRIVING STAPLEDRIVERS, now U.S. Pat. No. 7,500,979;

U.S. patent application Ser. No. 12/038,939, entitled STAPLE CARTRIDGESFOR FORMING STAPLES HAVING DIFFERING FORMED STAPLE HEIGHTS, now U.S.Pat. No. 7,934,630;

U.S. patent application Ser. No. 13/020,263, entitled SURGICAL STAPLINGSYSTEMS THAT PRODUCE FORMED STAPLES HAVING DIFFERENT LENGTHS, now U.S.Pat. No. 8,636,187;

U.S. patent application Ser. No. 13/118,278, entitledROBOTICALLY-CONTROLLED SURGICAL STAPLING DEVICES THAT PRODUCE FORMEDSTAPLES HAVING DIFFERENT LENGTHS, now U.S. Patent ApplicationPublication No. 2011/0290851;

U.S. patent application Ser. No. 13/369,629, entitledROBOTICALLY-CONTROLLED CABLE-BASED SURGICAL END EFFECTORS, now U.S. Pat.No. 8,800,838;

U.S. patent application Ser. No. 12/695,359, entitled SURGICAL STAPLINGDEVICES FOR FORMING STAPLES WITH DIFFERENT FORMED HEIGHTS, now U.S. Pat.No. 8,464,923;

U.S. patent application Ser. No. 13/072,923, entitled STAPLE CARTRIDGESFOR FORMING STAPLES HAVING DIFFERING FORMED STAPLE HEIGHTS, now U.S.Pat. No. 8,567,656;

U.S. patent application Ser. No. 13/766,325, entitled LAYER OF MATERIALFOR A SURGICAL END EFFECTOR; now U.S. Patent Application Publication No.2013/0256380;

U.S. patent application Ser. No. 13/763,078, entitled ANVIL LAYERATTACHED TO A PROXIMAL END OF AN END EFFECTOR; now U.S. PatentApplication Publication No. 2013/0256383;

U.S. patent application Ser. No. 13/763,094, entitled LAYER COMPRISINGDEPLOYABLE ATTACHMENT MEMBERS; now U.S. Patent Application PublicationNo. 2013/0256377;

U.S. patent application Ser. No. 13/763,106, entitled END EFFECTORCOMPRISING A DISTAL TISSUE ABUTMENT MEMBER; now U.S. Patent ApplicationPublication No. 2013/0256378;

U.S. patent application Ser. No. 13/433,147, entitled TISSUE THICKNESSCOMPENSATOR COMPRISING CHANNELS; now U.S. Patent Application PublicationNo. 2013/0256369;

U.S. patent application Ser. No. 13/763,112, entitled SURGICAL STAPLINGCARTRIDGE WITH LAYER RETENTION FEATURES; now U.S. Patent ApplicationPublication No. 2013/0256379;

U.S. patent application Ser. No. 13/763,035, entitled ACTUATOR FORRELEASING A TISSUE THICKNESS COMPENSATOR FROM A FASTENER CARTRIDGE; nowU.S. Patent Application Publication No. 2013/0214030;

U.S. patent application Ser. No. 13/763,042, entitled RELEASABLE TISSUETHICKNESS COMPENSATOR AND FASTENER CARTRIDGE HAVING THE SAME; now U.S.Patent Application Publication No. 2013/0221063;

U.S. patent application Ser. No. 13/763,048, entitled FASTENER CARTRIDGECOMPRISING A RELEASABLE TISSUE THICKNESS COMPENSATOR; now U.S. PatentApplication Publication No. 2013/0221064;

U.S. patent application Ser. No. 13/763,054, entitled FASTENER CARTRIDGECOMPRISING A CUTTING MEMBER FOR RELEASING A TISSUE THICKNESSCOMPENSATOR; now U.S. Patent Application Publication No. 2014/0097227;

U.S. patent application Ser. No. 13/763,065, entitled FASTENER CARTRIDGECOMPRISING A RELEASABLY ATTACHED TISSUE THICKNESS COMPENSATOR; now U.S.Patent Application Publication No. 2013/0221065;

U.S. patent application Ser. No. 13/763,021, entitled STAPLE CARTRIDGECOMPRISING A RELEASABLE COVER; now U.S. Patent Application PublicationNo. 2014/0224686;

U.S. patent application Ser. No. 13/763,078, entitled ANVIL LAYERATTACHED TO A PROXIMAL END OF AN END EFFECTOR; now U.S. PatentApplication Publication No. 2013/0256383;

U.S. patent application Ser. No. 13/763,095, entitled LAYER ARRANGEMENTSFOR SURGICAL STAPLE CARTRIDGES; now U.S. Patent Application PublicationNo. 2013/0161374;

U.S. patent application Ser. No. 13/763,147, entitled IMPLANTABLEARRANGEMENTS FOR SURGICAL STAPLE CARTRIDGES; now U.S. Patent ApplicationPublication No. 2013/0153636;

U.S. patent application Ser. No. 13/763,192, entitled MULTIPLE THICKNESSIMPLANTABLE LAYERS FOR SURGICAL STAPLING DEVICES; now U.S. PatentApplication Publication No. 2013/0146642;

U.S. patent application Ser. No. 13/763,161, entitled RELEASABLE LAYEROF MATERIAL AND SURGICAL END EFFECTOR HAVING THE SAME; now U.S. PatentApplication Publication No. 2013/0153641;

U.S. patent application Ser. No. 13/763,177, entitled ACTUATOR FORRELEASING A LAYER OF MATERIAL FROM A SURGICAL END EFFECTOR; now U.S.Patent Application Publication No. 2013/0146641;

U.S. patent application Ser. No. 13/763,037, entitled STAPLE CARTRIDGECOMPRISING A COMPRESSIBLE PORTION; now U.S. Patent ApplicationPublication No. 2014/0224857;

U.S. patent application Ser. No. 13/433,126, entitled TISSUE THICKNESSCOMPENSATOR COMPRISING TISSUE INGROWTH FEATURES; now U.S. PatentApplication Publication No. 2013/0256366;

U.S. patent application Ser. No. 13/433,132, entitled DEVICES ANDMETHODS FOR ATTACHING TISSUE THICKNESS COMPENSATING MATERIALS TOSURGICAL STAPLING INSTRUMENTS; now U.S. Patent Application PublicationNo. 2013/0256373;

U.S. patent application Ser. No. 13/851,703, entitled FASTENER CARTRIDGECOMPRISING A TISSUE THICKNESS COMPENSATOR INCLUDING OPENINGS THEREIN;now U.S. Patent Application Publication No. 2014/0291382;

U.S. patent application Ser. No. 13/851,676, entitled TISSUE THICKNESSCOMPENSATOR COMPRISING A CUTTING MEMBER PATH; now U.S. PatentApplication Publication No. 2014/0291379;

U.S. patent application Ser. No. 13/851,693, entitled FASTENER CARTRIDGEASSEMBLIES; now U.S. Patent Application Publication No. 2014/0291381;

U.S. patent application Ser. No. 13/851,684, entitled FASTENER CARTRIDGECOMPRISING A TISSUE THICKNESS COMPENSATOR AND A GAP SETTING ELEMENT; nowU.S. Patent Application Publication No. 2014/0291380;

U.S. patent application Ser. No. 14/187,387, entitled STAPLE CARTRIDGEINCLUDING A BARBED STAPLE, now U.S. Patent Application Publication No.2014/0166724;

U.S. patent application Ser. No. 14/187,395, entitled STAPLE CARTRIDGEINCLUDING A BARBED STAPLE, now U.S. Patent Application Publication No.2014/0166725;

U.S. patent application Ser. No. 14/187,400, entitled STAPLE CARTRIDGEINCLUDING A BARBED STAPLE, now U.S. Patent Application Publication No.2014/0166726;

U.S. patent application Ser. No. 14/187,383, entitled IMPLANTABLE LAYERSAND METHODS FOR ALTERING IMPLANTABLE LAYERS FOR USE WITH SURGICALFASTENING INSTRUMENTS, now U.S. Patent Application Publication No.2015/0238185;

U.S. patent application Ser. No. 14/187,386, entitled IMPLANTABLE LAYERSAND METHODS FOR ALTERING ONE OR MORE PROPERTIES OF IMPLANTABLE LAYERSFOR USE WITH FASTENING INSTRUMENTS, now U.S. Patent ApplicationPublication No. 2015/0239180;

U.S. patent application Ser. No. 14/187,390, entitled IMPLANTABLE LAYERSAND METHODS FOR MODIFYING THE SHAPE OF THE IMPLANTABLE LAYERS FOR USEWITH A SURGICAL FASTENING INSTRUMENT, now U.S. Patent ApplicationPublication No. 2015/0238188;

U.S. patent application Ser. No. 14/187,389, entitled IMPLANTABLE LAYERASSEMBLIES, now U.S. Patent Application Publication No. 2015/0238187;

U.S. patent application Ser. No. 14/187,385, entitled IMPLANTABLE LAYERSCOMPRISING A PRESSED REGION, now U.S. Patent Application Publication No.2015/0238191;

U.S. patent application Ser. No. 14/187,384, entitled FASTENING SYSTEMCOMPRISING A FIRING MEMBER LOCKOUT, now U.S. Patent ApplicationPublication No. 2015/0238186;

U.S. patent application Ser. No. 14/827,856, entitled IMPLANTABLE LAYERSFOR A SURGICAL INSTRUMENT;

U.S. patent application Ser. No. 14/827,907, entitled IMPLANTABLE LAYERSFOR A SURGICAL INSTRUMENT;

U.S. patent application Ser. No. 14/827,932, entitled IMPLANTABLE LAYERSFOR A SURGICAL INSTRUMENT;

U.S. patent application Ser. No. 14/667,874, entitled MALLEABLEBIOABSORBABLE POLYMER ADHESIVE FOR RELEASABLY ATTACHING A STAPLEBUTTRESS TO A SURGICAL STAPLER;

U.S. patent application Ser. No. 14/300,954, entitled ADJUNCT MATERIALSAND METHODS OF USING SAME IN SURGICAL METHODS FOR TISSUE SEALING;

U.S. patent application Ser. No. 14/840,613, entitled DRUG ELUTINGADJUNCTS AND METHODS OF USING DRUG ELUTING ADJUNCTS;

U.S. patent application Ser. No. 14/498,145, entitled METHOD FORCREATING A FLEXIBLE STAPLE LINE; and

U.S. patent application Ser. No. 14/865,306, entitled IMPLANTABLEADJUNCT SYSTEMS FOR DETERMINING ADJUNCT SKEW.

Numerous specific details are set forth to provide a thoroughunderstanding of the overall structure, function, manufacture, and useof the embodiments as described in the specification and illustrated inthe accompanying drawings. Well-known operations, components, andelements have not been described in detail so as not to obscure theembodiments described in the specification. The reader will understandthat the embodiments described and illustrated herein are non-limitingexamples, and thus it can be appreciated that the specific structuraland functional details disclosed herein may be representative andillustrative. Variations and changes thereto may be made withoutdeparting from the scope of the claims.

The terms “comprise” (and any form of comprise, such as “comprises” and“comprising”), “have” (and any form of have, such as “has” and“having”), “include” (and any form of include, such as “includes” and“including”) and “contain” (and any form of contain, such as “contains”and “containing”) are open-ended linking verbs. As a result, a surgicalsystem, device, or apparatus that “comprises,” “has,” “includes” or“contains” one or more elements possesses those one or more elements,but is not limited to possessing only those one or more elements.Likewise, an element of a system, device, or apparatus that “comprises,”“has,” “includes” or “contains” one or more features possesses those oneor more features, but is not limited to possessing only those one ormore features.

The terms “proximal” and “distal” are used herein with reference to aclinician manipulating the handle portion of the surgical instrument.The term “proximal” referring to the portion closest to the clinicianand the term “distal” referring to the portion located away from theclinician. It will be further appreciated that, for convenience andclarity, spatial terms such as “vertical”, “horizontal”, “up”, and“down” may be used herein with respect to the drawings. However,surgical instruments are used in many orientations and positions, andthese terms are not intended to be limiting and/or absolute.

Various exemplary devices and methods are provided for performinglaparoscopic and minimally invasive surgical procedures. However, thereader will readily appreciate that the various methods and devicesdisclosed herein can be used in numerous surgical procedures andapplications including, for example, in connection with open surgicalprocedures. As the present Detailed Description proceeds, the readerwill further appreciate that the various instruments disclosed hereincan be inserted into a body in any way, such as through a naturalorifice, through an incision or puncture hole formed in tissue, etc. Theworking portions or end effector portions of the instruments can beinserted directly into a patient's body or can be inserted through anaccess device that has a working channel through which an end effectorand elongated shaft of a surgical instrument can be advanced.

A surgical stapling system can comprise a shaft and an end effectorextending from the shaft. The end effector comprises a first jaw and asecond jaw. The first jaw comprises a staple cartridge. The staplecartridge is insertable into and removable from the first jaw; however,other embodiments are envisioned in which a staple cartridge is notremovable from, or at least readily replaceable from, the first jaw. Thesecond jaw comprises an anvil configured to deform staples ejected fromthe staple cartridge. The second jaw is pivotable relative to the firstjaw about a closure axis; however, other embodiments are envisioned inwhich the first jaw is pivotable relative to the second jaw. Thesurgical stapling system further comprises an articulation jointconfigured to permit the end effector to be rotated, or articulated,relative to the shaft. The end effector is rotatable about anarticulation axis extending through the articulation joint. Otherembodiments are envisioned which do not include an articulation joint.

The staple cartridge comprises a cartridge body. The cartridge bodyincludes a proximal end, a distal end, and a deck extending between theproximal end and the distal end. In use, the staple cartridge ispositioned on a first side of the tissue to be stapled and the anvil ispositioned on a second side of the tissue. The anvil is moved toward thestaple cartridge to compress and clamp the tissue against the deck.Thereafter, staples removably stored in the cartridge body can bedeployed into the tissue. The cartridge body includes staple cavitiesdefined therein wherein staples are removably stored in the staplecavities. The staple cavities are arranged in six longitudinal rows.Three rows of staple cavities are positioned on a first side of alongitudinal slot and three rows of staple cavities are positioned on asecond side of the longitudinal slot. Other arrangements of staplecavities and staples may be possible.

The staples are supported by staple drivers in the cartridge body. Thedrivers are movable between a first, or unfired position, and a second,or fired, position to eject the staples from the staple cavities. Thedrivers are retained in the cartridge body by a retainer which extendsaround the bottom of the cartridge body and includes resilient membersconfigured to grip the cartridge body and hold the retainer to thecartridge body. The drivers are movable between their unfired positionsand their fired positions by a sled. The sled is movable between aproximal position adjacent the proximal end and a distal positionadjacent the distal end. The sled comprises a plurality of rampedsurfaces configured to slide under the drivers and lift the drivers, andthe staples supported thereon, toward the anvil.

Further to the above, the sled is moved distally by a firing member. Thefiring member is configured to contact the sled and push the sled towardthe distal end. The longitudinal slot defined in the cartridge body isconfigured to receive the firing member. The anvil also includes a slotconfigured to receive the firing member. The firing member furthercomprises a first cam which engages the first jaw and a second cam whichengages the second jaw. As the firing member is advanced distally, thefirst cam and the second cam can control the distance, or tissue gap,between the deck of the staple cartridge and the anvil. The firingmember also comprises a knife configured to incise the tissue capturedintermediate the staple cartridge and the anvil. It is desirable for theknife to be positioned at least partially proximal to the rampedsurfaces such that the staples are ejected ahead of the knife.

The staple cartridge can also include an implantable layer. Theimplantable layer is configured to be captured within a staple alongwith tissue when the staple is deployed by the corresponding driver. Theimplantable layer can comprise a buttress, a tissue thicknesscompensator, and/or other adjunct material. A tissue thicknesscompensator is configured to compensate for variations in tissueproperties, such as variations in the thickness of tissue, for example,along a staple line. A tissue thickness compensator can be compressibleand resilient. In use, a tissue thickness compensator prevents or limitsthe over-compression of stapled tissue while facilitating adequatetissue compression within and between staples.

The implantable layer of a staple cartridge can be releasably secured tothe body of the staple cartridge. For example, the implantable layer canbe releasably secured to the deck of the staple cartridge with areleasable adhesive, at least one attachment tab, and/or otherattachment features. Additionally or alternatively, an implantable layercan be releasably secured to the first jaw or the second jaw. Animplantable layer can be positioned on the cartridge-side of an endeffector and/or the anvil-side of the end effector, for example.

An implantable layer can be configured to promote tissue ingrowth. Invarious instances, it is desirable to promote the ingrowth of tissueinto an implantable layer to promote the healing of the treated tissue(e.g. stapled and/or incised tissue) and/or to accelerate the patient'srecovery. More specifically, the ingrowth of tissue into an implantablelayer may reduce the incidence, extent, and/or duration of inflammationat the surgical site. Tissue ingrowth into and/or around the implantablelayer may manage the spread of infections at the surgical site, forexample. The ingrowth of blood vessels, especially white blood cells,for example, into and/or around the implantable layer may fightinfections in and/or around the implantable layer and the adjacenttissue. Tissue ingrowth may also encourage the acceptance of foreignmatter (e.g. the implantable layer and the staples) by the patient'sbody and may reduce the likelihood of the patient's body rejecting theforeign matter. Rejection of foreign matter may cause infection and/orinflammation at the surgical site.

Turning to the Drawings wherein like numerals denote like componentsthroughout the several views, FIG. 1 illustrates an exemplary surgicalstapling and severing instrument 8010 suitable for use with animplantable adjunct such as, for example, a tissue thicknesscompensator. The surgical stapling and severing instrument 8010 cancomprise an anvil 8014 which may be repeatedly opened and closed aboutits pivotal attachment to an elongate staple channel 8016. A stapleapplying assembly 8012 may comprise the anvil 8014 and the channel 8016,wherein the assembly 8012 can be proximally attached to an elongateshaft 8018 forming an implement portion 8022. When the staple applyingassembly 8012 is closed, or at least substantially closed, the implementportion 8022 can present a sufficiently small cross-section suitable forinserting the staple applying assembly 8012 through a trocar.

In various circumstances, the staple cartridge assembly 8012 ismanipulated by a handle 8020 connected to the elongate shaft 8018. Thehandle 8020 can comprise user controls such as a rotation knob 8030 thatrotates the elongate shaft 8018 and the staple applying assembly 8012about a longitudinal axis of the shaft 8018 and a closure trigger 8026,which can pivot in front of a pistol grip 8036 to close the stapleapplying assembly 8012. A closure release button 8038 is outwardlypresented on the handle 8020 when the closure trigger 8026 is clampedsuch that the release button 8038 can be depressed to unclamp theclosure trigger 8026 and open the staple applying assembly 8012, forexample.

A firing trigger 8034, which can pivot in front of the closure trigger8026, causes the staple applying assembly 8012 to simultaneously severand staple tissue clamped therein. In various circumstances, multiplefiring strokes can be employed using the firing trigger 8034 to reducethe amount of force required to be applied by the surgeon's hand perstroke. In certain embodiments, the handle 8020 can comprise one or morerotatable indicator wheels such as, for example, rotatable indicatorwheel 8041 which can indicate the firing progress. A manual firingrelease lever 8042 can allow the firing system to be retracted beforefull firing travel has been completed, if desired, and, in addition, thefiring release lever 8042 can allow a surgeon, or other clinician, toretract the firing system in the event that the firing system bindsand/or fails.

Additional details on the surgical stapling and severing instrument 8010and other surgical stapling and severing instruments suitable for usewith the present disclosure are described, for example, in U.S. patentapplication Ser. No. 13/851,693, entitled FASTENER CARTRIDGE ASSEMBLY,and filed on Mar. 27, 2013, now U.S. Patent Application Publication No.2014/0291381, the entire disclosure of which is incorporated herein byreference. Furthermore, powered surgical stapling and severinginstruments can also be utilized with the present disclosure. See, forexample, U.S. Patent Application Publication No. 2009/0090763, entitledPOWERED SURGICAL STAPLING DEVICE, and filed on Aug. 12, 2008, the entiredisclosure of which is incorporated herein by reference.

With reference to FIGS. 2 and 3, a firing assembly such as, for example,firing assembly 9090 can be utilized with the surgical stapling andsevering instrument 8010 to advance a wedge sled 9126 which comprises aplurality of wedges 9204 configured to deploy staples from the stapleapplying assembly 8012 into tissue captured between the anvil 8014 andthe elongate staple channel 8016. Furthermore, an E-beam 9102 at adistal portion of the firing assembly 9090 may fire the staples from thestaple applying assembly 8012 as well as position the anvil 8014relative to the elongate staple channel 8016 during firing. The E-beam9102 includes a pair of top pins 9110, a pair of middle pins 9112 whichmay follow portion 9218 of the wedge sled 9126, and a bottom pin or foot9114, as well as a sharp cutting edge 9116 which can be configured tosever the captured tissue as the firing assembly 9090 is advanceddistally. In addition, integrally formed and proximally projecting topguide 9118 and middle guide 9120 bracketing each vertical end of thecutting edge 9116 may further define a tissue staging area 9122assisting in guiding tissue to the sharp cutting edge 9116 prior tobeing severed. The middle guide 9120 may also serve to engage and firethe staple applying assembly 8012 by abutting a stepped central member9124 of the wedge sled 9126 (FIG. 2) that effects staple formation bythe staple applying assembly 8012.

In various circumstances, a staple cartridge can comprise means forcompensating for the thickness of tissue captured within staplesdeployed from a staple cartridge. Referring to FIG. 4, a staplecartridge, such as staple cartridge 10000, for example, can be utilizedwith the surgical stapling and severing instrument 8010 and can includea rigid first portion, such as support portion 10010, for example, and acompressible second portion, such as tissue thickness compensator 10020,for example. The support portion 10010 can comprise a cartridge body anda plurality of staple cavities 10012. A staple 10030, for example, canbe removably positioned in each staple cavity 10012. Referring primarilyto FIGS. 4 and 5, each staple 10030 can comprise a base 10031 and one ormore legs 10032 extending from the base 10031. Prior to the staples10030 being deployed, the bases 10031 of the staples 10030 can besupported by staple drivers positioned within the support portion 10010and, concurrently, the legs 10032 of the staples 10030 can be at leastpartially contained within the staple cavities 10012.

In various circumstances, the staples 10030 can be deployed between anunfired position and a fired position such that the legs 10032 movethrough the tissue thickness compensator 10020, penetrate through a topsurface of the tissue thickness compensator 10020, penetrate the tissueT, and contact an anvil positioned opposite the staple cartridge 10000.As the legs 10032 are deformed against the anvil, the legs 10032 of eachstaple 10030 can capture a portion of the tissue thickness compensator10020 and a portion of the tissue T within each staple 10030 and apply acompressive force to the tissue. Further to the above, the legs 10032 ofeach staple 10030 can be deformed downwardly toward the base 10031 ofthe staple to form a staple entrapment area in which the tissue T andthe tissue thickness compensator 10020 can be captured. In variouscircumstances, the staple entrapment area can be defined between theinner surfaces of the deformed legs 10032 and the inner surface of thebase 10031. The size of the entrapment area for a staple can depend onseveral factors such as the length of the legs, the diameter of thelegs, the width of the base, and/or the extent in which the legs aredeformed, for example.

In use, further to the above and referring primarily to FIG. 4, ananvil, such as anvil 8014 of the surgical stapling and severinginstrument 8010, can be moved into a closed position opposite the staplecartridge 10000 by depressing the closure trigger 8026 to advance theE-beam 9102. The anvil 8014 can position tissue against the tissuethickness compensator 10020 and, in various circumstances, compress thetissue thickness compensator 10020 against the support portion 10010,for example. Once the anvil 8014 has been suitably positioned, thestaples 10030 can be deployed, as also illustrated in FIG. 4.

In various circumstances, as mentioned above, a staple-firing sled10050, which is similar in many respects to the sled 9126 (See FIG. 3),can be moved from a proximal end of the staple cartridge 10000 toward adistal end 10002, as illustrated in FIG. 5. As the firing assembly 9090is advanced, the sled 10050 can contact the staple drivers 10040 andlift the staple drivers 10040 upwardly within the staple cavities 10012.In at least one example, the sled 10050 and the staple drivers 10040 caneach comprise one or more ramps, or inclined surfaces, which canco-operate to move the staple drivers 10040 upwardly from their unfiredpositions. As the staple drivers 10040 are lifted upwardly within theirrespective staple cavities 10012, the staple drivers 10040 can lift thestaples 10030 upwardly such that the staples 10030 can emerge from theirstaple cavities 10012. In various circumstances, the sled 10050 can moveseveral staples upwardly at the same time as part of a firing sequence.

Referring to FIG. 5, the staple legs 10032 of the staples 10030 canextend into the compensator 10020 beyond the support portion 10010 whenthe staples 10030 are in their unfired positions. In variouscircumstances, the tips of the staple legs 10032, or any other portionof the staple legs 10032, may not protrude through a toptissue-contacting surface 10021 of the tissue thickness compensator10020 when the staples 10030 are in their unfired positions. In certaincircumstances, the tips of the staple legs 10032 can comprise sharp tipswhich can incise and penetrate the tissue thickness compensator 10020.

Referring to FIG. 6, a staple cartridge assembly 10 is illustrated. Thestaple cartridge assembly 10 includes a staple cartridge 12. The staplecartridge 12 is similar in many respects to the staple cartridge 10000.Like the staple cartridge 10000, the staple cartridge 12 includes aplurality of staples which are housed in a plurality of cavities orpockets 22 defined in the staple cartridge 12. Also, the plurality ofstaples of the staple cartridge 12 can be deployed by the surgicalstapling and severing instrument 8010.

The staple cartridge 12 further includes a cartridge deck 16 with anouter surface 18. The staple cartridge 12 also includes a knife slot 20that accommodates the cutting edge 9116 as it is advanced to cut tissuecaptured by the surgical stapling and severing instrument 8010. Theplurality of pockets 22 may extend from the outer surface 18 into thestaple cartridge 12 for housing the plurality of staples. Advancement ofthe sled 10050 through the staple cartridge 12 causes the staples ofstaple cartridge 12 to be deployed from their respective pockets 22 intotissue in the same, or substantially the same, manner that the staples10030 are deployed from the staple cartridge 10000, as described above.

Referring again to FIG. 6, the staple cartridge assembly 10 furtherincludes a tissue thickness compensator or compressible adjunct 14. Thecompressible adjunct 14 is attached to the outer surface 18 by partiallymelting the compressible adjunct 14 onto the outer surface 18 to allowthe melted portions of the compressible adjunct 14 to flow onto theouter surface 18. The melted portions of the compressible adjunct 14 areresolidified by cooling, for example, which causes the compressibleadjunct 14 to be attached to the outer surface 18.

In certain instances, the staple cartridge 12 may include one or moreheating elements (not shown) configured to heat the outer surface 18.The heated outer surface 18 can melt the portions of the compressibleadjunct 14 in contact therewith. Upon resolidifying, the melted portionsof the compressible adjunct 14 can define attachment regions that securethe compressible adjunct 14 to the outer surface the outer surface 18.

In at least one instance, the outer surface 18 is heated uniformly.Alternatively, specific zones of the outer surface 18 are directlyheated while other zones are not directly heated. The zones that are notdirectly heated can be referred to herein as “unheated.” The portions ofthe compressible adjunct 14 in contact with, or in close proximity to,the directly heated zones can be melted and then resolidified to definethe attachment regions between the compressible adjunct 14 and the outersurface 18. The portions of the compressible adjunct 14 in contact with,or in close proximity to, the unheated zones remain unattached to theouter surface 18.

In at least one instance, the outer surface 18 is uniformly, or at leastsubstantially uniformly, heated but certain zones of the outer surface18 may have greater thermal conductivity than other zones of the outersurface 18. In such instances, the portions of the compressible adjunct14 in contact with, or in close proximity to, the higher thermalconductivity zones can be melted and resolidified to define theattachment regions between the compressible adjunct 14 and the outersurface 18, while the portions of the compressible adjunct 14 in contactwith, or in close proximity to, the lower thermal conductivity zonesremain unattached to the outer surface 18.

As described above, selective or localized heating of certain zones ofthe outer surface 18 can be used to define or create discrete attachmentregions between the compressible adjunct 14 and the outer surface 18.Alternatively, the compressible adjunct 14 can be especially designed,as illustrated in FIG. 6, to yield selective attachment regions in thepresence of a uniformly heated outer surface 18.

In various instances, the zones of the outer surface 18 destined to bondwith the compressible adjunct 14 are treated to improve the bond. In atleast one instance, one or more of such bonding zones may comprise anirregular topography. For example, such bonding zones may comprise agreater roughness than the remainder of the outer surface 18. Under onenon-limiting theory, the greater roughness may improve bonding with themelted portions of the compressible adjunct 14 by increasing the surfacearea available for contact with the melted portions of the compressibleadjunct 14.

The desired roughness of the bonding zones can be achieved by anysuitable process such as, for example, mechanical abrading, chemicaletching, shot peening, laser peening, and/or plasma spraying. Otherprocesses for producing the desired roughness are contemplated by thepresent disclosure.

Further to the above, the compressible adjunct 14 includes a body 24.The body 24 includes a face 26 positionable against at least a portionof the outer surface 18 of the staple cartridge 12. The face 26 mayinclude a plurality of attachment regions 28 and a plurality ofnon-attachment regions 30, as illustrated in FIG. 6. Selectiveattachment of the compressible adjunct 14 to the outer surface 18 at theattachment regions 28 can reduce the force needed to release thecompressible adjunct 14 from the cartridge deck 16 as compared to wherethe entire face of a compressible adjunct is attached to the surface 18.

The attachment regions 28 are comprised of one or more biocompatiblematerials. Likewise, the non-attachment regions 30 are comprised of oneor more biocompatible materials. In various instances, at least one ofthe biocompatible materials forming the attachment regions 28 isexcluded from the biocompatible materials forming the non-attachmentregions 30. In such instances, the one or more biocompatible materialsforming the non-attachment regions 30 have melting temperatures that aregreater than the melting temperature of the excluded biocompatiblematerial of the attachment regions 28. In certain instances, theattachment regions 28 are comprised of a biocompatible material “A”, abiocompatible material “B”, and a biocompatible material “C,” while thenon-attachment regions 30 are comprised of the biocompatible material“A” and the biocompatible material “B” but exclude the biocompatiblematerial “C.” In such instances, the biocompatible material “C” has alower melting temperature than the biocompatible material “A” and thebiocompatible material “B.” Upon heating the attachment regions 28 andthe non-attachment regions 30 to the melting temperature of thebiocompatible material “C,” the biocompatible material “C” melts andflows from the attachment regions 28 onto the outer surface 18. Once thebiocompatible material “C” is resolidified bonding is establishedbetween the attachment regions 28 and the outer surface 18.

In at least one instance, the non-attachment regions 30 may be comprisedof a first biocompatible material, and the attachment regions 28 may becomprised of a second biocompatible material which is different from thefirst biocompatible material. The second biocompatible material may havea lower melting temperature than the first biocompatible material. Insuch instances, exposing the face 26 to the outer surface 18, which isuniformly heated to a temperature greater than or equal to the meltingtemperature of the second biocompatible material but lower than themelting temperature of the first biocompatible material, causes theattachment regions 28 to melt and flow onto the outer surface 18. Thenon-attachment regions 30, however, will remain in their solid state asthe temperature of the outer surface 18 is below the melting temperatureof the first biocompatible material. Upon resolidifying, the attachmentregions 28 releasably secure the body 24 of the compressible adjunct 14to the outer surface 18 of the cartridge deck 16.

In various instances, one or more of the non-attachment regions 30and/or one or more of the attachment regions 28 may comprisebioabsorbable materials such as, for example, polyglycolic acid (PGA)which is marketed under the trade name VICRYL, polylactic acid (PLA orPLLA), polydioxanone (PDS), polyhydroxyalkanoate (PHA), poliglecaprone25 (PGCL) which is marketed under the trade name Monocryl, and/orpolycaprolactone (PCL). In certain instances, one or more of theattachment regions 28 and/or the non-attachment regions 30 may compriseone or more composite materials that include two or more polymers, thepolymers selected from a group including PGA, PLA, PDS, PHA, PGCL and/orPCL, for example. In at least one instance, the second biocompatiblematerial is comprised of PDS.

In at least one instance, the compressible adjunct 14 is secured to thecartridge deck 16 by causing a temporary phase transition in the secondbiocompatible material of the attachment regions 28 while thecompressible adjunct 14 is pressed, or positioned, against the cartridgedeck 16. In certain instances, the temporary phase transition in thesecond biocompatible material is not accompanied by a phase transitionin the first biocompatible material of the non-attachment regions 30.

In certain instances, the attachment regions 28 are resolidified byremoving or deactivating the heat source. In at least one instance, theheat source is an oven, which is configured to receive the staplecartridge 12 and the compressible adjunct 14 positioned against thecartridge deck 16. The oven can be heated to a suitable temperatureprior to and/or after receiving the staple cartridge 12 and thecompressible adjunct 14. In at least one instance, the heat source canbe a thermal resistance circuit, which can be activated to heat theouter surface 18. The thermal resistance circuit can be arranged underthe cartridge deck 16, for example. Other suitable heat sources arecontemplated by the present disclosure. In certain instances, theattachment regions 28 are resolidified by active cooling in addition toremoving or deactivating the heat source. For example, a fan or anyother cooling system can be employed to cool the attachment regions 28to a temperature below the melting temperature of the secondbiocompatible material.

In at least one instance, the non-attachment regions 30 may be comprisedof a plurality biocompatible materials with melting temperatures thatare greater than a predetermined temperature. Likewise, the attachmentregions 28 may be comprised of a plurality of biocompatible materials;however, the biocompatible materials of the attachment regions 28include at least one biocompatible material having a melting temperaturethat is equal to or less than the predetermined melting temperature.Said another way, the biocompatible materials of the attachment regions28 include at least one biocompatible material having a meltingtemperature that is less than the melting temperatures of thebiocompatible materials of the non-attachment regions 30. Upon heatingthe face 26 of the compressible adjunct 14 to the predeterminedtemperature, the attachment regions 28 are melted, or at least partiallymelted, for bonding with the outer surface 18, while the non-attachmentregions 30 remain in their solid phase and do not bond to the outersurface 18.

In various instances, further to the above, the non-attachment regions30 need only exclude biocompatible materials with melting temperaturesthat are equal to or less than the melting temperature of thebiocompatible material with the lowest melting temperature in theattachment regions 28. That said the attachment regions 28 need not belimited in composition to one biocompatible material. On the contrary,the attachment regions 28 can be comprised of a plurality ofbiocompatible materials as long as the plurality of biocompatiblematerials of the attachment regions 28 includes at least onebiocompatible material with a melting temperature that is less than themelting temperature(s) of the biocompatible material(s) of thenon-attachment regions 30.

Referring again to FIG. 6, the body 24 of the compressible adjunct 14may include a fibrous construct comprising a plurality of fibers.Suitable compressible adjuncts may include meshes, other filamentousstructures, non-woven structures, sponges, woven or non-woven materials,knit or non-knit materials, felts, salt eluted porous materials, moldedporous materials, and/or 3D-printing generated adjuncts, for example.Other techniques for preparing the compressible adjunct 14 arecontemplated by the present disclosure.

In at least one instance, the non-attachment regions 30 may include afirst plurality of fibers, and the attachment regions 28 may include asecond plurality of fibers different from the first plurality of fibers.For example, the second plurality of fibers may have a lower meltingtemperature than the first plurality of fibers. In such instances,exposing the face 26 of the compressible adjunct 14 to the outer surface18, which is uniformly heated to a temperature which is greater than orequal to the melting temperature of the second plurality of fibers butlower than the melting temperature of the first plurality of fibers,causes the second plurality of fibers of the attachment regions 28 tomelt and flow onto the outer surface 18. The first plurality of fibersof the non-attachment regions 30, however, will remain in their solidstate as the temperature of the outer surface 18 is below the meltingtemperature of the first plurality of fibers.

The fibrous construct of the body 24 of the compressible adjunct 14 canbe pressed onto or positioned against the outer surface 18 which isuniformly heated to a temperature sufficient to melt the fibers of theattachment regions 28 but not the fibers of the non-attachment regions30. Upon resolidifying, the melted fibers of the attachment regions 28secure the body 24 of the compressible adjunct 14 to the outer surface18 of the cartridge deck 16.

In various instances, the outer surface 18 may comprise bonding zonesfor bonding with the attachment regions 28. In certain instances, thebonding zones are treated to improve the bond between the attachmentregions 28 and the outer surface 18. In at least one instance, one ormore of the bonding zones may comprise an irregular topography thatincreases the roughness of the bonding zones compared to the remainderof the outer surface 18. As described above, the increased roughness maycorrespond to an increase in the surface area of the bonding zonesavailable for bonding with the attachment regions 28.

Referring to FIG. 7, a staple cartridge assembly 40 includes a staplecartridge 42 which is similar in many respects to the staple cartridges12 and 10000. Like the staple cartridge 10000, the staple cartridge 42includes a plurality of staples such as, for example, a plurality ofstaples 43 which are housed in the staple cartridge 42 in a plurality ofcavities or pockets 52. Furthermore, like the staples of the staplecartridge 10000, the staples 43 can be deployed from the staplecartridge 42 into captured tissue by the surgical stapling and severinginstrument 8010.

The staple cartridge 42 includes a cartridge deck 46. Like the cartridgedeck 16, the cartridge deck 46 includes an outer surface such as, forexample, an outer surface 48. The plurality of pockets 52 extend fromthe cartridge deck 46 into the staple cartridge 42 and are configured tohouse the plurality of staples 43, as illustrated in FIG. 7. When thestaple cartridge 42 is used with the surgical stapling and severinginstrument 8010, the advancement of the sled 10050 through the staplecartridge 42 causes the staples 43 to be deployed from their respectivepockets 52 into tissue in the same, or substantially the same, mannerthat the staples 10030 are deployed from the staple cartridge 10000.

The staple cartridge assembly 40 includes a layer such as, for example,a tissue thickness compensator or compressible adjunct. In theillustrated in embodiment, the staple cartridge assembly 40 includes acompressible adjunct 14. The compressible adjunct 14 is assembled with,or positioned against, the cartridge deck 46 of the staple cartridge 42.The compressible adjunct 14 is secured to a plurality of bonding zones56 on the cartridge deck 46, as described in greater detail below.

In certain instances, the bonding zones 56 can be arranged in rows. Eachrow may include a plurality of the bonding zones 56. In the embodimentillustrated in FIG. 7, the bonding zones 56 are arranged in threeparallel rows 56 a-56 c extending along a length of the cartridge deck46 on each side of the knife slot 20. Alternatively, the bonding zones56 may be arranged in two parallel rows along a length of the cartridgedeck 46 on each side of the knife slot 20. Alternatively, the bondingzones 56 may be arranged in a single row along a length of the cartridgedeck 46 on each side of the knife slot 20. Alternatively, the bondingzones 56 may be arranged in non-parallel rows. In certain instances, thebonding zones 56 may be arranged along a perimeter, or a periphery, ofthe cartridge deck 46.

The middle row 56 b is offset from the outer rows 56 a, 56 c. Saidanother way, a pair of the bonding zones of the outer rows 56 a, 56 c islaterally aligned with a gap between two consecutive bonding zones ofthe middle row 56 b. The gap may include a pocket 52. In certaininstances, a plurality of bonding zones 56 and a plurality of pockets 52may be arranged in a row such that each bonding zone 56 is disposedbetween two consecutive pockets 52, as illustrated in FIG. 7. Otherarrangements of the bonding zones 56 with respect to the cartridge deck46 are contemplated by the present disclosure.

As illustrated in FIG. 7, the cartridge deck 42 may include a pluralityof pocket extenders 54 which extend from the outer surface 48. Thepocket extenders 54 can serve a number of functions. For example, thepockets extenders 54 may protect the legs of the staples 43 that extendoutside the pockets 52 in their unfired positions. Also, the pocketextenders 54 may guide the staples 43 as they are being fired. A bondingzone 56 may extend between two adjacent pocket extenders 54 of twodifferent pockets 52. Said another way, the bonding zone 56 may extendbetween two adjacent atraumatic pocket extenders 54 each protecting astaple leg of a different staple.

In certain instances, a plurality of pocket extenders 54 may be arrangedwith a plurality of bonding zones 56 in a row such as, for example, therows 56 a-56 c. In at least one instance, each of the plurality ofbonding zones 56 in such a row can be positioned between two consecutiveatraumatic pocket extenders 54. For example, as illustrated in FIG. 7, abonding zone 56′ is positioned between a distal staple 43 a and proximalstaple 43 b such that the bonding zone 56′ extends between a firstpocket extender 54 a protecting a proximal leg 45 of the distal staple43 a and a second pocket extender 54 b protecting a distal leg (notshown) of the proximal staple 43 b.

As indicated above, the bonding zones 56 of the cartridge deck 46 mayextend from the outer surface 48. In other words, the bonding zones 56may be elevated, or stepped up, relative to the outer surface 48, asillustrated in FIG. 7. In various instances, the attachment regions 28can be positioned on the bonding zones 56. The elevation of the bondingzones 56 relative to the outer surface 48 can prevent, or at leastlimit, overflow of the melted material of the attachment regions 28outside the bonding zones 56, which can help maintain the attachmentbetween the compressible adjunct 14 and the cartridge deck 46 todiscrete regions defined by the bonding zones 56.

In various instances, the bonding zones 56 of the cartridge deck 46 aretreated to improve their attachment to corresponding attachment regions28 of the compressible adjunct 14. In at least one instance, one or moreof the bonding zones 56 may comprise an irregular topography, asillustrated in FIG. 7. In other words, the bonding zones 56 may comprisea greater roughness than the remainder of the outer surface 48. Thegreater roughness improves bonding with the melted attachment regions28. The desired roughness of the bonding zones can be achieved by anysuitable process such as, for example, mechanical abrading, chemicaletching, shot peening, laser peening, and/or plasma spraying. Otherprocesses for producing the desired roughness are contemplated by thepresent disclosure.

In various instances, the cartridge deck 46 may further include one ormore attachment members 58. The attachment members 58 aid in securingthe compressible adjunct 14 to the cartridge deck 46. In certaininstances, the attachment members 58 comprise barbs that can maintain aninitial alignment between the bonding zone 56 and the correspondingattachment regions 48 of the compressible adjunct 14 during the meltingand/or resolidifying processes used to bond the compressible adjunct 14to the cartridge deck 46. The compressible adjunct 14 can be pressedagainst the cartridge deck 46 so that the attachment members 58 engagethe face 26 of the compressible adjunct 14, and/or to establish aninitial alignment between the bonding zones 56 and the attachmentregions 28. The attachment regions 28 are then melted onto the bondingzones 56. Upon resolidifying, the attachment regions 58 secure thecompressible adjunct 14 to the bonding zones 56.

Referring now to FIG. 8, a staple cartridge assembly 60 is assembledwith a surgical stapling and severing instrument such as, for example,the surgical stapling and severing instrument 8010. The staple cartridgeassembly 60 includes a staple cartridge 62. The staple cartridge 62 issimilar in many respects to the staple cartridges 12, 42, and 10000. Thestaple cartridge 62 includes a cartridge deck 66, which includes anouter surface such as, for example, an outer surface 68. The staplecartridge assembly 60 further includes a compressible layer 64 and abonding layer 65. The bonding layer 65 can be comprised of a pluralityof bonding islands 67, as illustrated in FIG. 8. The bonding islands 67can be spaced apart from one another and disposed on the outer surface68 of the cartridge deck 66 in a predetermined arrangement. The bondingislands 67 are arranged in a pattern surrounding, or at least partiallysurrounding, the knife slot 20. Said another way, the bonding islands 67are arranged in a pattern along a periphery, or a perimeter, of theknife slot 20. Other arrangements of the bonding islands 67 onto theouter surface 68 are contemplated by the present disclosure.

In certain instances, one or more of the bonding islands 67 comprise acylindrical shape, as illustrated in FIG. 8. Other shapes are alsocontemplated by the present disclosure. For example, one or more bondingislands 67 may comprise a dome shape. In the embodiment illustrated inFIG. 8, a bonding island 67′ is disposed in the outer surface 68 atdistal portion thereof, which is distal to the knife slot 20.

In various instances, the bonding islands 67 of the bonding layer 65 canbe formed with the cartridge deck 66 during manufacturing.Alternatively, the bonding layer 65 can be attached to the cartridgedeck 66 by the surgeon, for example. Any suitable attachment techniquecan be employed to secure the boding layer 65 to the cartridge deck 66.In at least one instance, the bonding layer 65 may include one or moreconnecting straps 69, for example. The connecting straps 69 alsointerconnect the bonding islands 67, and can be employed to secure theboding layer 65 to the cartridge deck 66, for example.

In any event, the compressible layer 64 can be secured to the cartridgedeck 66 by pressing, or positioning, the compressible layer 64 againstthe melted, or at least partially melted, bonding islands 67, thenallowing, or causing, the bonding islands 67 to resolidify. Said anotherway, the compressible layer 64 can be secured to the cartridge deck 66by causing a temporary phase transition in the bonding islands 67 whilethe compressible layer 64 is pressed, or positioned, against the bondingislands 67.

In one embodiment, the compressible layer 64 is pressed, or positioned,against the bonding islands 67. Then, the bonding islands 67 are heatedto a predetermined temperature which causes the bonding islands 67 to bemelted, or at least partially melted. Finally, the bonding islands 67are cooled, or allowed to cool, down below the predetermined temperaturethereby causing the bonding islands 67 to resolidify and secure thecompressible layer 64 to the cartridge deck 66. Alternatively, thebonding islands 67 can be heated to the predetermined temperature priorto pressing, or positioning, the compressible layer 64 against thebonding islands 67.

In certain instances, the bonding islands 67 are resolidified byremoving or deactivating the heat source. In other instances, thebonding islands 67 are resolidified by active cooling in addition toremoving or deactivating the heat source. For example, a fan or anyother cooling system can be employed to cool the bonding islands 67 to atemperature below the predetermined temperature.

In at least one instance, the compressible layer 64 may be comprised ofa first biocompatible material, and the bonding islands 67 may becomprised of a second biocompatible material which is different from thefirst biocompatible material. The second biocompatible material may havea lower melting temperature than the first biocompatible material. Insuch instances, heating the bonding islands 67 to the meltingtemperature of the second biocompatible material but lower than themelting temperature of the first biocompatible material, causes thebonding islands 67 to melt and flow into the compressible layer 64 andonto the outer surface 68. The compressible layer 64, however, willremain in a solid phase. Upon resolidifying, the bonding islands 67secure the compressible layer 64 to the outer surface 68 of thecartridge deck 66.

In at least one instance, the compressible layer 64 is secured to thecartridge deck 66 by causing a temporary phase change or transition inthe second biocompatible material of the bonding islands 67 while thecompressible layer 64 is pressed, or positioned, against the cartridgedeck 66. In certain instances, the temporary phase change in the secondbiocompatible material is not accompanied by a phase change in the firstbiocompatible material of the compressible layer 64.

In various instances, the compressible layer 64 and/or the bonding layer67 may comprise bioabsorbable materials such as, for example,polyglycolic acid (PGA) which is marketed under the trade name Vicryl,polylactic acid (PLA or PLLA), polydioxanone (PDS), polyhydroxyalkanoate(PHA), poliglecaprone 25 (PGCL) which is marketed under the trade nameMonocryl, and/or polycaprolactone (PCL). In certain instances, thecompressible layer 64 and/or the bonding layer 67 may comprise compositematerials that include two or more polymers, the polymers selected froma group including PGA, PLA, PDS, PHA, PGCL and/or PCL, for example. Inat least one instance, the second biocompatible material is comprised ofPDS, for example.

The reader will appreciate that the compressible adjuncts and/or layersof the present disclosure can be attached to an anvil such as, forexample, the anvil 8014 of the surgical stapling and severing instrument8010 in the same manner the compressible adjuncts and/or layers areattached to the staple cartridges of the present disclosure, and viceversa. For example, the compressible adjunct 14 can be attached to theanvil 8014 by uniformly heating the anvil 8014 to a temperaturesufficient to melt the fibers of the attachment regions 28 but not thefibers of the non-attachment regions 30. Upon resolidifying, the meltedfibers of the attachment regions 28 secure the body 24 of thecompressible adjunct 14 to the anvil 8014. Likewise the bonding layer 65can be employed to secure the compressible layer 64 to the anvil 8014 inthe same manner the bonding layer 65 secures the compressible layer 64to the staple cartridge 62.

Referring primarily to FIGS. 1 and 9, a surgical stapling and severinginstrument such as, for example, the surgical stapling and severinginstrument 8010 may include a compressible adjunct assembly 104. Thecompressible adjunct assembly 80 can be attached to a jaw member of thesurgical stapling and severing instrument 8010. In at least oneinstance, the compressible adjunct assembly 104 is attached to an anvilsuch as, for example, an anvil 84 (FIG. 9), which is similar in manyrespects to the anvil 8014 (FIG. 1).

Alternatively, the compressible adjunct assembly 104 can be attached toa staple cartridge such as, for example, the staple cartridge 10000. Incertain instances, a first compressible adjunct assembly 104 is attachedto an anvil and a second compressible adjunct assembly 104 is attachedto a staple cartridge of the same surgical stapling and severinginstrument. In such instances, tissue is captured between the first andsecond compressible adjunct assemblies 104 upon transitioning thesurgical stapling and severing instrument to a closed configuration.

Like the anvil 8014, the anvil 84 includes an elongate slot 86 thatextends through a length of the anvil 84 defining a first outer surface88 extending on a first side 90 of the elongate slot 86, and a secondouter surface 92 extending on a second side 94 of the elongate slot 86,as illustrated in FIG. 9. In certain instances, the anvil 84 is movablerelative to a staple cartridge such as, for example, the staplecartridge 10000 to capture tissue therebetween. Alternatively, thestaple cartridge 10000 can be moved relative to the anvil 84 to capturetissue therebetween. Alternatively, the anvil 84 and the staplecartridge 10000 can be moved toward one another to capture the tissuetherebetween. A firing assembly such as, for example, the firingassembly 9090 (FIG. 3) can be utilized with the surgical stapling andsevering instrument 8010 to deploy staples from the staple applyingassembly 8012 (FIG. 1) into tissue captured between the anvil 84 and thestaple cartridge 10000, as described in greater detail above.

Referring to FIG. 9, the first outer surface 88 includes a plurality ofpockets 96. Likewise, the second outer surface 92 includes a pluralityof pockets 98. The pockets 96 and 98 can be configured to receive anddeform the staples as they are deployed from the staple cartridge 10000,for example. Furthermore, the elongate slot 86 can be configured toaccommodate the cutting edge 9116 (FIG. 3) as it is advanced to cuttissue captured by the surgical stapling and severing instrument 8010.

Referring to FIGS. 3 and 9, the anvil 84 may include an internal surface100 that defines an internal space 102 within the anvil 84. The pins9110 (FIG. 3) of the firing assembly 9090 can ride against the internalsurface 102, and can be motivated through the internal space 102 as thefiring assembly 9090 is advanced to deploy the staples into the tissuecaptured by the staple applying assembly 8012.

Referring again to FIG. 9, the compressible adjunct assembly 104includes an attachment layer 106, a first compressible adjunct 108, anda second compressible adjunct 110. The attachment layer 106 can beconfigured to couple the first compressible adjunct 108 and the secondcompressible adjunct 110 to the anvil 84, as described in greater detailbelow. A first section 106 a of the attachment layer 106 is positionableon the first side 90 of the elongate slot 86, and a second section 106 bis positionable on the second side 94 of the elongate slot 86. Theelongate slot 86 separates the first section 106 a from the secondsection 106 b. An intermediary section 106 c of the attachment layer 106extends between the first section 106 a and the second section 106 b.The intermediary section 106 c bridges the elongate slot 86. In certaininstances, the intermediary section 106 c only partially bridges theelongate slot 86

In certain instances, the intermediary section 106 c completely bridgesthe elongate slot 86. In at least one instance, the intermediary section106 c may be comprised of a plurality of bridging portions 107, asillustrated in FIG. 9. Each bridging portion 107 extends between thefirst section 106 a and the second section 106 b. The bridging portions107 are spaced apart from one another. Gaps 109 in the intermediarysection 106 b separate the bridging portions 107. The gaps 109 exposethe elongate slot 86.

As illustrated in FIG. 9, the bridging portions 107 can be strategicallyarranged along the elongate slot 86 to maintain the integrity of theattachment layer 106 while minimizing the firing force needed to drivethe cutting edge 9116 (FIG. 3) as it is advanced to cut the intermediatelayer 106 c and tissue captured between a staple cartridge and the anvil84. The gaps 109 and the bridging portions 107 alternate in positionalong at least a portion of the elongate slot 86.

Various techniques for manufacturing a compressible adjunct assemblysuch as, for example, the compressible adjunct assembly 104 aredescribed in U.S. patent application Ser. No. 14/187,383, entitledIMPLANTABLE LAYERS AND METHODS FOR ALTERING IMPLANTABLE LAYERS FOR USEWITH SURGICAL FASTENING INSTRUMENTS, and filed Feb. 24, 2014, now U.S.Patent Application Publication No. 2015/0238185, the entire disclosureof which is incorporated herein by reference. In at least one instance,the attachment layer 106 can be attached to the first compressibleadjunct 108 and second compressible adjunct 110 during fabrication ofthe first compressible adjunct 108 and second compressible adjunct 110using a lyophilization process, for example.

Alternatively, the attachment layer 106 can be attached to the firstcompressible adjunct 108 and second compressible adjunct 110 afterfabrication of the first compressible adjunct 108 and secondcompressible adjunct 110. For example, as described in greater detailelsewhere herein, the first compressible adjunct 108 can be positioned,or pressed, against a partially melted first section 106 a of theattachment layer 106. Upon resolidification, the first section 106 a isattached to the first compressible adjunct 108. In a similar manner, thefirst section 106 a can be attached to the first outer surface 88, thesecond section 106 b can be attached to the outer surface 92, and thesecond section 106 b can be attached to the second compressible adjunct110, for example.

As illustrated in FIG. 9, the first section 106 a of the attachmentlayer 106 extends between the first compressible adjunct 108 and thefirst outer surface 88. Likewise, the second section 106 b of theattachment layer 106 may extend between the second compressible adjunct110 and the outer surface 92. The first section 106 a completelyseparates the first compressible adjunct 108 from the first outersurface 88. In addition, the second section 106 b completely separatesthe second compressible adjunct 110 from the outer surface 92.Alternatively, a compressible adjunct assembly may comprise anattachment layer 206 that only partially separates one or morecompressible adjuncts from an anvil. Said another way, the first section106 a may include one or more gaps configured to expose the firstcompressible adjunct 108 to the first outer surface 88. Likewise, thesecond section 106 b may include one or more gaps configured to exposethe second compressible adjunct 110 to the outer surface 92.

The attachment layer 106 comprises a height that is smaller than theheight of the first compressible adjunct 108 and/or the height of thesecond compressible adjunct 110. Alternatively, the attachment layer 106may comprise a height that is greater than or equal to the height of thefirst compressible adjunct 108 and/or the height of the secondcompressible adjunct 110. In at least one instance, the attachment layer106 is comprised of a film, which can be attached to the firstcompressible adjunct 108 and/or the second compressible adjunct 108.

Referring to FIG. 10, a compressible adjunct assembly 204 may comprisean attachment layer 206 that partially separates a first compressibleadjunct 208 from the first outer surface 88 and/or partially separates asecond compressible adjunct 210 from the outer surface 92. Thecompressible adjunct assembly 204 is similar in many respects to thecompressible adjunct assembly 104. The compressible adjunct assembly 204can be assembled with the anvil 84.

The attachment layer 206 of the compressible adjunct assembly 204includes a first section 206 a positionable on the first side 90 of theelongate slot 86, and a second section 206 b positionable on the secondside 94 of the elongate slot 86. Also, an intermediary section 206 c ofthe attachment layer 206 extends between the first section 206 a and thesecond section 206 b. The intermediary section bridges the elongate slot86, as illustrated in FIG. 10. In certain instances, the intermediarysection 206 c only partially bridges the elongate slot 86.

The first compressible adjunct 208 of the compressible adjunct assembly204 is attached to the first section 206 a, and the second compressibleadjunct 210 of the compressible adjunct assembly 204 is attached to thesecond section 206 b. When the compressible adjunct assembly 204 isassembled with the anvil 84, as illustrated in FIG. 10, the firstcompressible adjunct 208 extends laterally beyond the first section 206a in a first direction away from the elongate slot 86. In addition, thefirst outer surface 88 also extends laterally beyond the first section206 a in the first direction. Likewise, the second compressible adjunct210 extends laterally beyond the second section 206 b in a seconddirection away from the elongate slot 86 and opposite the firstdirection. In addition, the outer surface 92 also extends laterallybeyond the second section 206 b in the second direction. In result, asillustrated in FIG. 10, an external portion 208 a of the firstcompressible adjunct 208 is in direct contact with the outer surface 88while a stepped internal portion 208 b is separated from the outersurface 88 by the first section 206 a of the attachment layer 206.Likewise, an external portion 210 a of the second compressible adjunct210 is in direct contact with the outer surface 92 while a steppedinternal portion 210 b is separated from the outer surface 92 by thesecond section 206 b of the attachment layer 206.

The stepped internal portions 208 b and 210 b define first and secondboundaries 208 c and 210 c, respectively. The attachment layer 206extends laterally between the first boundary 208 c and the secondboundary 210 c crossing the elongate slot 86 to interconnect the firstcompressible adjunct 208 and the second compressible adjunct 210. Whenthe compressible adjunct assembly 204 is assembled with the anvil 84, asillustrated in FIG. 10, the attachment layer 206 is positioned against acentral area of the anvil 84 extending between an inner row of thepockets 96 and an inner row of the pockets 98. In addition, the internalstepped portions 208 b and 210 b are separated from the anvil 84 by theattachment layer 206.

Further to the above, the first boundary 208 c is interior to the innerrow of the pockets 96, and the second boundary 210 c is interior to theinner row of the pockets 98. The first section 206 a of the attachmentlayer 206 is positioned against a portion of the outer surface 88extending between the elongate slot 86 and the inner row of the pockets96. In addition, the external portion 208 a is directly positionedagainst the pockets 96 of the outer surface 88. Likewise, the secondsection 206 b of the attachment layer 206 is positioned against aportion of the outer surface 92 extending between the elongate slot 86and the inner row of the pockets 98. In addition, the external portion210 a is directly positioned against the pockets 98 of the outer surface92. In certain instances, the boundaries 208 c and 210 c can be furtherspaced apart laterally to allow the attachment layer 206 to furtherencompass one or more of the rows of the pockets 96 and/or one or moreof the rows of the pockets 98.

The attachment layer 206 comprises a height that is smaller than theheight of the first compressible adjunct 208 and/or the height of thesecond compressible adjunct 210. Alternatively, the attachment layer 206may comprise a height that is greater than or equal to the height of thefirst compressible adjunct 208 and/or the height of the secondcompressible adjunct 210. In at least one instance, the attachment layer206 is comprised of a film, which can be attached to the internalstepped portion 208 b of the first compressible adjunct 208 and/or tothe internal stepped portion 210 b of the second compressible adjunct108.

Referring to FIGS. 11-15, a compressible adjunct assembly 304 includesan attachment layer 306 that includes a raised, elevated, or stepped upintermediary section 306 c. The compressible adjunct assembly 304 issimilar in many respects to the compressible adjunct assembly 104. Forexample, the compressible adjunct assembly 304 can be assembled with theanvil 84, as illustrated in FIG. 11. Also, the first compressibleadjunct 108 of the compressible adjunct assembly 304 can be attached toa first section 306 a of the attachment layer 306, and the secondcompressible adjunct 110 of the compressible adjunct assembly 304 can beattached to a second section 306 b of the attachment layer 306, forexample.

The intermediary section 306 c is configured to protrude into a gapdefined between the first compressible adjunct 108 and the secondcompressible adjunct 110. Alternatively, the intermediary section 306 ccan be configured to protrude into the elongate slot 86 when thecompressible adjunct assembly 304 is assembled with the anvil 84, asillustrated in FIG. 12. In certain instances, the intermediary section306 c may include a first portion configured to protrude into theelongate slot 86 and a second portion configured to protrude into thegap defined between the first compressible adjunct 108 and the secondcompressible adjunct 110.

In certain instances, the intermediary section 306 c serves as analignment feature for aligning the first compressible adjunct 108against the first section 306 a of the attachment layer 306 and/oraligning the second compressible adjunct 110 against the second section306 b of the attachment layer 306. As illustrated in FIG. 11, theintermediary section 306 c includes side walls 320 and 322. The firstcompressible adjunct 108 is configured to abut against the side wall320, and the second compressible adjunct 108 is configured to abutagainst the side wall 322.

In certain instances, the intermediary section 306 c serves as analignment feature for aligning the attachment layer 306 in positionagainst the anvil 84. As illustrated in FIGS. 12 and 13, theintermediary section 306 c includes include a plurality of projections307 that are insertable into the elongate slot 86. The projections 307are spaced apart from one another and arranged longitudinally in a rowalong a length of the intermediary section 306 c. In at least oneinstance, the projections 307 can be equidistant from one another.Alternatively, the projections 307 can be arranged closer to each otherin a first portion of the intermediary section 306 c than a secondportion of the intermediary section 306 c. In at least one instance, oneor more of the projections 307 comprises a top surface with arectangular, or at least substantially rectangular, shape. Other shapesare contemplated by the present disclosure such as, for example, acircular shape or a dome shape.

Further to the above, the projections 307 are arranged longitudinally ina row along a length of the elongate slot 86, and are dimensioned to fitinto the elongate slot 86. The projections 307 serve as alignmentfeatures for aligning the attachment layer 306 in position against theanvil 84. In certain instances, the projections 307 can be dimensionedto fit into the gap defined between the first compressible adjunct 108and the second compressible adjunct 110. The projections 307 can serveas alignment features for aligning the first compressible adjunct 108against the first section 306 a of the attachment layer 306 and/oraligning the second compressible adjunct 110 against the second section306 b of the attachment layer 306.

In at least one instance, the opening of the elongate slot 86 isslightly greater than the widths the projections 307. Alternatively, theopening of the elongate slot 86 can be slightly smaller than the widthsthe projections 307, which may cause the projections 307 to be slightlydeformed as they are pressed into the elongate slot 86. The deformedprojections 307 may serve as anchoring features for securing thecompressible adjunct assembly 304 to the anvil 84.

Referring to FIGS. 14 and 15, tissue is sandwiched between thecompressible adjunct assembly 304 and a compressible adjunct assembly311. The tissue is stapled and cut using a surgical stapling andsevering instrument such as, for example, the surgical stapling andsevering instrument 8010. A plurality of staples 305 are deployed from astaple cartridge such as, for example, the staple cartridge 1000 (FIG.17) to capture the tissue between the compressible adjunct assembly 304and the compressible adjunct assembly 311. The captured tissue issevered along with the projections 307 of the attachment layer 306 asthe cutting edge 9116 (FIG. 3) is advanced through the longitudinal slot86. The compressible adjunct assembly 304, originally attached to theanvil 84, is now released from the anvil 84 and remains with the stapledtissue in the patient's body. Likewise, compressible adjunct assembly311, originally attached to the staple cartridge 10000, is now releasedfrom the staple cartridge 10000 and remains with the stapled tissue inthe patient's body.

In the embodiment illustrated in FIG. 16, the intermediary section 306 cincludes a bar 309 extending longitudinally along a length of theintermediary section 306 c. The bar 309 comprises a top surface with arectangular, or at least substantially rectangular, shape. Other shapesare contemplated by the present disclosure such as, for example, a domeshape or a curved shape. The bar 309 extends longitudinally along alength of the elongate slot 86, and is dimensioned to fit into theelongate slot 86. In at least one instance, the bar 309 is dimensionedto snuggly or tightly fit into the elongate slot 86. In at least oneinstance, the opening of the elongate slot 86 is slightly greater thanthe width of the bar 309. Alternatively, the opening of the elongateslot 86 can be slightly smaller than the width of the bar 309, which maycause of the bar 309 to be slightly deformed as it is pressed into theelongate slot 86. The deformed bar 309 may serve as an anchoring featurefor securing the compressible adjunct assembly 304 to the anvil 84. Inaddition, the bar 309 can serve as an alignment feature for aligning theattachment layer 306 in position against the anvil 84.

Like the projections 307, the bar 309 can be dimensioned to fit into thegap defined between the first compressible adjunct 108 and the secondcompressible adjunct 110. The bar 309 can serve as an alignment featurefor aligning the first compressible adjunct 108 against the firstsection 306 a of the attachment layer 306 and/or aligning the secondcompressible adjunct 110 against the second section 306 b of theattachment layer 306.

Referring to FIG. 17, a compressible adjunct assembly 404 is assembledwith the anvil 84. The compressible adjunct assembly 404 is similar inmany respects to the compressible adjunct assembly 104. For example, thecompressible adjunct assembly 404 includes the attachment layer 106. Asdescribed above in greater detail, the attachment layer 106 includes thebridging portions 107 that extend between the first section 106 a andthe second section 106 b.

As illustrated in FIG. 17, the compressible adjunct assembly 404 alsoincludes a compressible layer or adjunct 408, which is similar in manyrespects to the compressible adjuncts 108 and 110. In addition, thecompressible adjunct 408 includes a first compressible portion 408 apositionable on the first side 90 of the elongate slot 86, and a secondcompressible portion 408 b positionable on the second side 94 of theelongate slot 86. In other words, the elongate slot 86 separates thefirst compressible portion 408 a from the second compressible portion408 b when the compressible adjunct assembly 404 is assembled with theanvil 84. An intermediary compressible portion 408 c of the compressibleadjunct 408 extends between the first compressible portion 408 a and thesecond compressible portion 408 b. The intermediary compressible portion408 c bridges the elongate slot 86, as illustrated in FIG. 17. Incertain instances, the intermediary compressible portion 408 c onlypartially bridges the elongate slot 86. In certain instances, theintermediary compressible portion 408 c completely covers the elongateslot 86.

Referring to FIG. 17, the intermediary compressible portion 408 cincludes of a plurality of bridging portions 407 extending between thefirst compressible portion 408 a and the second compressible portion 408b. The bridging portions 407 are spaced apart from one another in thesame, or at least substantially the same, manner the bridging portions107 of the attachment layer 106 are spaced from one another. The gaps109 defined between the bridging portions 107 also extend betweencorresponding bridging portions 407 which are aligned with the bridgingportions 107 such that the elongate slot 86 is exposed through the Gaps109. In certain instances, however, the bridging portions 107 and thebridging portions 407 can be out of alignment preventing or reducingthorough gaps.

The attachment layer 106 comprises a height that is smaller than theheight of the compressible adjunct 408. Said another way, the attachmentlayer 106 can be thinner than the compressible adjunct 408.Alternatively, in certain instances, the attachment layer 106 maycomprise a height that is greater than or equal to the height of thecompressible adjunct 408. In at least one instance, the attachment layer106 is comprised of a film, which can be attached to the compressibleadjunct 408 such that the bridging portions 407 are aligned with thebridging portions 107, as illustrated in FIG. 17.

Referring to FIGS. 18 and 16, a compressible adjunct assembly 504includes a compressible layer 506, a first attachment member 508, and asecond attachment member 510. It is envisioned that the compressibleadjunct assembly 504 includes only one attachment member. Alternatively,the compressible adjunct assembly 504 may include three or moreattachment members. As illustrated in FIG. 19, the compressible adjunctassembly 504 can be assembled with a jaw member of a surgical staplingand severing instrument such as, for example, the anvil 84 of thesurgical stapling and severing instrument 8010. The attachment members508 and 510 are configured to releasably attach the compressible layer506 to the anvil 84.

Referring again to FIG. 19, the cutting edge 9116 has severed thecompressible layer 506 of the compressible adjunct assembly 504 into afirst compressible portion 506 a on the first side 90 of the anvil 84and a second compressible portion 506 b on the second side 92 of theanvil 84. Tissue Captured by the surgical stapling and severinginstrument 8010 can also be severed along with the compressible layer506 by the cutting edge 9116 as the cutting edge 9116 is advancedthrough the elongate slot 86. A first portion of the severed tissue maybe stapled was the first compressible portion 506 a, and a secondportion of the severed tissue may be stapled with the secondcompressible portion 506 b.

In certain instances, the first compressible portion 506 a and thesecond compressible portion 506 b can be independent members that areseparately attached to the anvil 84. In such instances, the cutting edge9116 may not sever the compressible layer 506 while severing thecaptured tissue, as described above. Instead, the cutting edge 9116 maypass between the first compressible portion 506 a and the secondcompressible portion 506 b.

Referring again to FIGS. 18 and 16, the attachment members 508 and 510are spaced apart from each other. A passage 512 extends between theattachment members 508 and 510 for accommodating the cutting edge 9116as the cutting edge 9116 is advanced through the elongate slot 86. Whenthe compressible adjunct assembly 504 is assembled with the anvil 84,the first attachment member 508 is matingly engaged with a first ledge91 of the first side 90 of the anvil 84 and the second attachment member510 is matingly engaged with a second ledge 93 of the second side 92 ofthe anvil 84. The attachment members 508 and 510 comprise “C” shapedprofiles that are dimensioned and/or sufficiently resilient to snap fitaround the ledges 93 and 95, respectively, to secure the compressibleadjunct assembly to the anvil 84. Matting recesses 514 and 516 of theattachment members 508 and 510, respectively, are configured to receivethe ledges 91 and 93, respectively.

Further to the above, the first attachment member 508 includes a firstattachment portion 508 a positionable against an internal portion 100′of the internal surface 100. The internal portion 100′ may form a topsurface of the first ledge 91. A second attachment portion 508 b of theattachment member 508 is attached to an intermediate compressibleportion 506 c of the compressible layer 506. A coupling portion 508 cinterconnects the first attachment portion 508 a and the secondattachment portion 508 b. The coupling portion 508 c extends into theelongate slot 86, and is positioned against a side wall 95 of the ledge91.

Like the first attachment member 508, the second attachment member 510includes a first attachment portion 510 a positionable against aninternal portion 100″ of the internal surface 100. The internal portion100″ may form a top surface of the second ledge 93. A second attachmentportion 510 b of the attachment member 510 is attached to theintermediate compressible portion 506 c of the compressible layer 506.Like the coupling portion 508 c, a coupling portion 510 c interconnectsthe first attachment portion 510 a and the second attachment portion 510b. The coupling portion 510 c extends into the elongate slot 86, and ispositioned against a side wall 97 of the ledge 97.

As illustrated in FIG. 18, the attachment members 508 and 510, whenassembled with the compressible layer 506, are oriented such that secondattachment member 510 is a mirror-image of the first attachment member508. The attachment members 508 and 510 extend along the compressiblelayer 506 in parallel, or at least substantially in parallel, with eachother. The space between the coupling portion 508 c and the couplingportion 510 c defines the passage 512 which is configured to accommodatethe advancement of the cutting edge 9116, as described above.Furthermore, the pins 9110 (FIG. 3) of the firing assembly 9090 rideagainst the first attachment portions 508 a and 510 a as the firingassembly 9090 is advanced to deploy the staples into the tissue capturedby the surgical stapling and severing instrument 8010.

Referring again to FIG. 18, the attachment members 508 and 510 extendalong the entire length of the compressible layer 506. Alternatively,the attachment members 508 and 510 may extend along a portion of thelength of the compressible layer 506. In at least one instance, theattachment members 508 and 510 may extend along a middle portion of thelength of the compressible layer 506. In at least one instance, thefirst attachment member 508 extends along a first portion of the lengthof the compressible layer 506, while the second attachment member 510extends along a second portion of the length of the compressible layer506 that is different from the first portion.

In certain instances, one or both of the second attachment portions 508b and 510 b can be embedded in the intermediate compressible portion 506c. In at least one instance, one or both of the second attachmentportions 508 b and 510 b can be inserted, or partially inserted, into asolution that is lyophilized to produce the compressible layer 506.Alternatively, one or both of the second attachment portions 508 b and510 b can be attached to the compressible layer 506 after fabrication ofthe compressible layer 506. Any suitable attachment technique can beemployed in attaching the second attachment portions 508 b and 510 b tothe compressible layer 506 such as, for example, a biocompatibleadhesive.

Referring to FIG. 20, a compressible adjunct assembly 604 is depicted.The compressible adjunct assembly 604 is similar in many respects to thecompressible adjunct assembly 504. For example, the compressible adjunctassembly 604 can be assembled with a jaw member of a surgical staplingand severing instrument such as, for example, the anvil 84 of thesurgical stapling and severing instrument 8010. However, thecompressible adjunct assembly 604 does not include spaced apartattachment members. Instead, the attachment members are united in theform of a single attachment layer 607 that is shaped to form theattachment portions 508 a and 510 a. The attachment layer 607 isconfigured to releasably attach the compressible adjunct assembly 604 tothe anvil 84.

In at least one instance, the attachment layer 607 is formed as a flat,or at least substantially flat, layer or film which is modified to adesired shape that comprises the attachment portions 508 a and 510 a.Alternatively, the attachment layer 607 can take its desired shapeduring formation. For example, a mold comprising the desired shape canreceive a melted biocompatible material, which is solidified inside themold forming the desired shape of the attachment layer 607. Othertechniques for manufacturing the attachment layer 607 are contemplatedby the present disclosure.

Referring again to FIG. 20, the attachment layer 607 includes the secondan intermediate attachment portion 609 which replaces the attachmentportions 508 b and 510 b. The intermediate attachment portion 609 isattached to the intermediate compressible portion 506 c. In at least oneinstance, the intermediate attachment portion 609 is embedded, or atleast partially embedded, in the intermediate compressible portion 506c. Furthermore, coupling portions 508 c and 510 c protrude from oppositeends of the intermediate attachment portion 609, in a direction awayfrom the intermediate compressible portion 506 c of the compressiblelayer 506, to define the passage 512. The cutting edge 9116 is advancedthrough the passage 512 between the coupling portions 508 c and 510 c asit cuts through the intermediate attachment portion 609, theintermediate compressible portion 506 c, and the captured tissue duringthe firing sequence.

Mating recesses 614 and 616 are defined between the attachment layer 607and the compressible layer 506 on opposite sides from the passage 512,as illustrated in FIG. 20. The mating recesses 614 and 616 areconfigured to receive the ledges 91 and 93, respectively. When thecompressible adjunct assembly 604 is assembled with the anvil 84, theledge 91 is positioned between the first attachment portion 508 a andthe first compressible portion 506 a of the compressible layer 506, andthe ledge 93 is positioned between the first attachment portion 510 aand the second compressible portion 506 b of the compressible layer 506.

In certain instances, the attachment layer 607 and/or the compressiblelayer 506 may comprise variations in thickness and/or edge conditions toreduce the potential for tissue trauma in surrounding tissue and/or tohelp maintain the integrity of the compressible adjunct assembly 604during attachment, manipulation, and/or release from the anvil 84. In atleast one instance, the attachment layer 607 and/or the compressiblelayer 506 are reinforced with atraumatic and/or thicker edges.

Referring to FIG. 21, the attachment layer 607′ includes rolled edges620 and 622, which reduce the potential for tissue trauma in surroundingtissue. In addition, the attachment layer 607′ is reinforced withrelatively thicker regions 624 and 626 at the intermediate attachmentportion 609 to improve the robustness of the compressible adjunctassembly 604 during attachment, manipulation, and/or release from theanvil 84. Other high stress areas in the compressible adjunct assembly604 can also be reinforced in the same, or a similar, manner.

Referring now to FIGS. 22-24, a compressible adjunct assembly 704includes the compressible layer 506 and a plurality of attachmentmembers 708 that are spaced apart from one another and arrangedlongitudinally in a row along a length of the compressible layer 506. Incertain instances, the attachment members 708 are arranged along acentral portion of the compressible layer 506. In certain instances, theattachment members 708 are arranged along a distal portion and/or aproximal portion of the compressible layer 506. Like the attachmentmembers 508 and 510, the attachment members 708 are configured toreleasably attach the compressible layer 506 to the anvil 84. However,unlike the attachment members 508 and 510, each attachment member 708 iscapable of being positioned against the ledges 95 and 97 simultaneously.The attachment members 708 are severed by the cutting edge 9116 as thecutting edge 9116 is advanced through the elongate slot 86 to cut thecompressible layer 506 and the captured tissue.

The attachment members 708 each comprise a base 710, a stem 712extending from the base, and a head or crown 714 extending from the stem712. When the compressible adjunct assembly 704 is assembled with theanvil 84, the stem 712 is positioned in the elongate slot 86, asillustrated in FIG. 23, and the head 714 resides in the internal space102 within the anvil 84. The head 714 comprises a transversecross-sectional area that resembles the shape of a dome which extendslaterally beyond the stem 712 to simultaneously engage the internalsurfaces 100′ and 100″ of the anvil 84, as illustrated in FIG. 23. Othershapes of the head 714 are contemplated by the present disclosure.

Lateral extensions 716 and 718 of the head 714 comprise flat surfaces720 and 722, respectively, which rest against the internal surfaces 100′and 100″, respectively. The surfaces 720 and 722 need not be completelyflat. In certain instances, the surfaces 720 and 722 can be roughened toimprove traction against the internal surfaces 100′ and 100″. Grippingfeatures may be incorporated into the surfaces 720 and 722. In certaininstances, a biocompatible adhesive may be employed to bond the surfaces720 and 722 to the internal surfaces 100′ and 100″, for example.

Referring again to FIG. 22, the head 714 and/or the stem 712 areconfigured to bend in the distal direction as the E-beam 9102 isadvanced distally against the head 714 during the firing sequence. Theproximally projecting top guide 9118 may push against the head 714causing the head 714 to bend forward and downward to allow room for thepassage of the E-beam 9102. The pins 9110 may pass on top of the lateralextensions 716 and 718. As the lateral extensions 716 and 718 flattenagainst the internal surfaces 100′ and 100″, the head 714 may assist inblocking tissue ahead of the E-beam 9102 from entering the internalspace 102 and disrupting the advancement of the pins 9110. This addedfunctionality can improve the performance of the firing assembly 9090and reduce potential trauma to the treated tissue by preventing thetreated tissue from being entrapped within the anvil 84. As illustratedin FIG. 22, the head 714 and the stem 712 comprise a reduced transversecross-sectional area. In other words the head 714 and the stem 712 aresubstantially flattened to improve bending and/or facilitate insertionof the head 714 into the internal space 102. Also, in various instances,the head 714 and/or the stem 712 are comprised, or at least partiallycomprised, of a resilient biocompatible material to improve bendingand/or facilitate insertion of the head 714 into the internal space 102.

Referring to FIG. 24, the base 710 is embedded in the compressible layer506. In certain instances, the base 710 is only partially embedded inthe compressible layer 506. In certain instances, the base 710 is notembedded into the compressible layer 506, but instead is attached to anexterior surface thereof. For example, a biocompatible adhesive can beemployed to attach the base 710 to the compressible layer 506. Asillustrated in FIG. 24, the base 710 defines an axis A-A whichintersects an axis B-B defined by the stem 712 at an angle α. The angleα is 90°. In certain instances, the angle α is greater than 90°. Inother instances, the angle α is less than 90°.

As illustrated in FIG. 24, the stem 712 protrudes from a proximal endportion of the base 710. Alternatively, the stem 712 may protrude from adistal end portion of the base 710. Alternatively, the stem 712 mayprotrude from a central portion of the base 710. As illustrated in FIG.22, the base 712 comprises a rectangular shape. The rectangular-shapedthe bases 710 are aligned longitudinally along the longitudinal slot 86when the compressible adjunct assembly 704 is assembled with the anvil84. Other shapes, sizes, and arrangements of the bases 712 arecontemplated by the present disclosure. In at least one instance, a base712 may comprise a circular shape and a stem 714 may protrude from thecenter of the circular base 712.

Referring now to FIGS. 25-28, a compressible adjunct assembly 804includes a compressible layer 806 that is attached to a plurality ofattachment members 808. The compressible adjunct assembly 804 is similarin many respects to the compressible adjunct assemblies 504, 604, and704. For example, the compressible adjunct assembly 804 can be assembledwith a jaw member of a surgical stapling and severing instrument suchas, for example, the anvil 84 of the surgical stapling and severinginstrument 8010. As described in greater detail below, the attachmentmembers 808 releasably attach the compressible layer 806 to the anvil84.

The compressible layer 806 includes an intermediate compressible portion806 c extending longitudinally between a first compressible portion 806a and a second compressible portion 806 b. A plurality of slots 809 aredefined in the intermediate compressible portion 806 c. The slots 809are spaced apart from one another and arranged longitudinally in a rowalong a length of the compressible layer 806. In certain instances, theslots 809 are arranged along a central portion of the intermediatecompressible portion 806 c of the compressible layer 806. In certaininstances, the slots 809 are arranged along a distal portion and/or aproximal portion of the intermediate compressible portion 806 c. Whenthe compressible adjunct assembly 804 is assembled with the anvil 84,the slots 809 are aligned with the elongate slot 86 such that thecutting edge 9116 passes through the slots 809 during distal advancementof the cutting edge 9116. This reduces friction against the cutting edge9116 which prolongs the life of the cutting edge 9116 and/or reduces theforce required to advance the firing assembly 9090.

Referring to FIG. 25, the attachment members 808 are spaced apart fromone another and arranged longitudinally along a length of theintermediate compressible portion 806 c such that the attachment members808 alternate between two sides 814 and 816 of a plane define by theslots 809. Other positions and arrangements of the attachment members808 with respect to the compressible layer 806 are contemplated by thepresent disclosure. Each attachment member 808 is positioned against aslot 809. Alternatively, an attachment member 808 can be positionedbetween two consecutive slots 809.

The attachment members 808 comprise a generally curved shape which canimprove the stiffness of the attachment members 808. Other shapes arecontemplated by the present disclosure. As illustrated in FIG. 25, theattachment members 808 comprise a partial cylindrical frame with aconcave side 820 facing away from the slots 809 and a convex side 818facing toward the slots 809. The attachment members 808 further comprisea coupling portion 808 c extending between an attachment portion 808 aand a base 808 b. The attachment portion 808 a comprise lateralextensions 810 that are configured to rest against the internal surface100′ or the internal surface 100″ to secure the compressible adjunctassembly 804 to the anvil 84.

Further to the above, the base 808 b includes tabs 824 configured tosecure the attachment member 808 to the compressible layer 806. In atleast one instance, as illustrated in FIG. 26, a base 808 b includes asingle tab 824 that is received in a bifurcated portion 826 of thecompressible layer 806. In at least one instance, as illustrated in FIG.27, a base 808 b includes two tabs 824 that are configured to receive aportion 828 of the compressible layer 806 therebetween. In at least oneinstance, as illustrated in FIG. 28, a base 808 a includes a tab 824that comprises a slot 830. The portion 828 of the compressible layer 806can be twisted and inserted into the slot 830 to secure the attachmentmember 808 to the compressible layer 806.

Referring now to FIG. 29, a compressible adjunct assembly 904 isassembled with an anvil 984. The anvil 984 is similar in many respectsto the anvil 84 (FIG. 9) and the anvil 8014 (FIG. 1). For example, theanvil 984 includes the elongate slot 86 which defines a first outersurface 988 extending on the first side 90 of the elongate slot 86, anda second outer surface 992 extending on the second side 94 of theelongate slot 86. Also, the anvil 984 is movable relative to a staplecartridge such as, for example, the staple cartridge 10000 to capturetissue therebetween. The outer surfaces 988 and 992 of the anvil 984 arestepped, as illustrated in FIG. 29. In other embodiments, however, ananvil can include planar outer surfaces that are not stepped. In atleast one instance, an anvil may include a central surface that isoffset from two lateral surfaces. Other anvils with various shapes andsurfaces are contemplated by the present disclosure.

In any event, the compressible adjunct assembly 904 includes a firstattachment layer 908 positionable against the first outer surface 988and a second attachment layer 910 positionable against the second outersurface 992. As illustrated in FIG. 29, the first attachment layer 908is releasably attached to the second attachment layer 910. Attachmentmembers 916 and 918 extend laterally from the attachment layers 908 and916, respectively. The attachment members 916 and 918 includeinterlocking portions 912 and 920, respectively, and distal end portions914 and 922, respectively. The distal end portions 914 and 922 aretucked under the ledges 91 and 93, respectively, to secure thecompressible adjunct assembly 904 to the anvil 984, as illustrated inFIG. 29. Although one pair of the attachment members 916 and 918 isshown, it is understood that the first layer 908 may include a pluralityof the attachment members 916 which can be interlocked with a pluralityof the attachment members 918 extending from the second layer 910.

Referring to FIG. 30, the interlocking portions 912 and 920 may includeinterlocking slots 913 and 921, respectively, which can be configuredfor mating engagement with one another. In at least one instance, abiocompatible adhesive can be employed to reinforce the engagementbetween the slot 913 and 921.

Referring to FIGS. 31-34, the attachment layers 908 and 910 are furtherjoined by a distal end portion 930 that includes a bent or rolled tab932 which is tucked or inserted into a distal end of the anvil 984 tosecure the compressible adjunct assembly 904 to the anvil 984. Asillustrated in FIG. 32, the distal end portion 930 can be comprised oftwo separated end portions 934 and 936 extending from the layers 908 and910, respectively. The end portions 934 and 936 are joined together toform the distal end portion 930. As illustrated in FIG. 33, the endportions 934 and 936 may comprise dovetail-shaped transverse joints 938and corresponding dovetail-shaped transverse slots 940 for matingengagement with the dovetail-shaped transverse joints 938. Othercoupling features for attaching the end portions 934 and 936 to form thedistal end portion 930 are contemplated by the present disclosure.

A staple cartridge assembly 1000 comprising a cartridge body 1010 and animplantable adjunct 1030 is depicted in FIGS. 35 and 36. The cartridgebody 1010 comprises a cartridge deck, or adjunct facing surface, 1013and a plurality of staple cavities 1015 defined in the deck 1013. Thestaple cartridge assembly 1000 further comprises a plurality of staples1020 positioned in the staple cavities 1015 and a plurality of stapledrivers 1011 configured to drive the staples 1020 out of the staplecavities 1015. Each staple 1020 comprises staple legs 1021 and a staplebase 1023 from which the staple legs 1021 extend. In an unfired state,the staples 1020 are stored within the cartridge body 1010 such that thestaple legs 1021 partially extend out of the staple cavity 1015 beyond,or above, the cartridge deck 1013. The staple legs 1021 can at leastpartially extend into the implantable adjunct 1030 when the staples 1020are in their unfired state. Embodiments are envisioned in which thestaple legs do not extend above the cartridge deck 1013 when the staplesare in their unfired state.

The implantable adjunct 1030 comprises at least one attachment feature1031 comprising deck-attachment portions 1033. Each attachment feature1031 comprises a unitary structure, for example, and is configured toreleasably hold, or attach, the implantable adjunct 1030 to thecartridge deck 1013. Each attachment feature 1031 traverses a staplecavity 1015 such that, when the staple 1020 in the staple cavity 1015 isdeployed from the staple cavity 1015, the attachment feature 1031 isengaged, broken, and/or torn, by the staple base 1023 of the staple 1020to release a portion of the implantable adjunct 1030 from the cartridgedeck 1013. The attachment feature 1031 may traverse the cavity 1015 in adirection which is perpendicular to, or at an angle with respect to, thestaple cavity 1015. As illustrated in FIGS. 35 and 36, the attachmentfeatures 1031 extend laterally across the staple cavities 1015. Variousalternative embodiments are envisioned where multiple attachmentfeatures traverse each staple cavity 1015 such that the staple bases1023 of the staples 1020 must engage and overcome multiple attachmentfeatures to release the adjunct 1030 from the cartridge deck 1013. Otherembodiments are envisioned where one attachment portion spans multiplestaple cavities requiring more than one staple to contact and dislodgethe attachment portion.

The attachments features 1031 are attached to the adjunct 1030 in anysuitable manner. In at least one instance, the attachments features 1031comprise fibers which are woven into the adjunct 1030, for example. Inat least one such instance, the adjunct 1030 is comprised of interwovenfibers and the attachment features 1031 are interwoven into the adjunct1030. In certain instances, the attachment features 1031 are adhered tothe adjunct 1030 utilizing at least one adhesive. In at least one suchinstance, the adjunct 1030 comprises a film and the attachment features1031 are bonded to the film. In any event, the deck-attachment portions1033 of the attachment features 1031 can be attached to the deck 1013 inany suitable manner. In at least one instance, the attachment portions1033 can be adhered to the deck 1013 utilizing at least one adhesive. Incertain instances, the attachment features 1031 of the adjunct 1030 canbe heated and then pressed against the deck 1013 in order to attach thedeck-attachment portions 1033 to the deck 1013.

Attaching the adjunct to the cartridge in the above-described mannerpermits segments of the adjunct to stay attached to the cartridge deckuntil the staples which capture such segments of the adjunct aredeployed. Attaching the adjunct to the cartridge in this manner alsoprovides multiple, distinct attachment locations which are progressivelyreleased as the firing assembly incises and staples tissue. For example,as the firing assembly travels from a proximal end of the staplecartridge assembly to a distal end of the staple cartridge assembly, theproximal-most staples are deployed from the staple cartridge before thedistal-most staples are deployed which, as a result, releases theproximal end of the adjunct before the distal end of the adjunct. Statedanother way, the attachment features that have not yet been engaged bytheir respective staples remain attached to the cartridge deck duringthe firing progression until the firing assembly reaches those staples.

Further to the above, FIG. 36 depicts a staple base 1023 of a staple1020 after it has engaged and released an attachment feature 1031 of theadjunct 1030 from the cartridge deck 1013. The attachment feature 1031comprises break-away portions which are configured to fail once a forceis applied to the attachment feature 1031 by the staple base 1023 thatexceeds a threshold force. Upon reaching the threshold force, theattachment feature 1031 is configured to break, rip, and/or tear inorder to release the adjunct 1030 from the cartridge deck 1013. Thedeck-attachment portions 1033 are configured to remain attached to thecartridge deck 1013 when the attachment feature 1031 breaks. Otherembodiments are envisioned where the detachment of the attachmentportions 1033 from the cartridge deck 1013 are responsible for therelease of the adjunct 1030 from the cartridge deck 1013. In suchembodiments, the attachment feature 1031 disengages from the cartridgedeck 1013 entirely.

In addition to or in lieu of the above, the deck 1013 can be treatedand/or cleaned before the adjunct 1030 is attached to the deck 1013.Such treatment and/or cleaning can improve the bond between the adjunct1030 and the deck 1013. In at least one instance, surfactants, soaps,and/or lubricants are used to facilitate the loading, or insertion, ofthe staples into the staple cavities and, in such instances, the deck1013, or at least portions of the deck 1013, can be screened to preventor inhibit surfactants, soaps, and/or lubricants from flowing onto thedeck 1013. One such soap comprises sodium stearate, for example. Incertain instances, lasers, plasma and/or IR heating can be utilized toclean the deck 1013, or at least portions of the deck 1013, in order toimprove the adhesion between the attachment features 1031 and the deck1013.

A surgical stapling assembly 1100 is depicted in FIG. 37 and FIG. 38.The surgical stapling assembly 1100 comprises an anvil 1160, a staplecartridge assembly 1110, and an implantable adjunct 1130. The staplecartridge assembly 1110 comprises a cartridge body comprising aplurality of staple cavities 1111 and a deck surface 1113, a pluralityof staples 1120 removably stored within the staple cavities 1111, and aplurality of staple drivers 1140 configured to drive the staples 1120out of the staple cavities 1111 toward the anvil 1160 of the surgicalstapling assembly 1100. The staple cartridge assembly 1110 alsocomprises a sled 1150 configured to convert the linear motion of afiring assembly into vertical motion of the staple drivers 1140 to drivethe staples 1120 out of the staple cavities 1111. The sled 1150comprises an initial contact ramp 1151, an intermediate contact surface1153, and a final contact ramp 1155 all configured to contact the stapledrivers 1140 as the firing assembly drives the sled 1150 from a proximalend of the cartridge assembly 1110 to a distal end of the cartridgeassembly 1110.

Each staple driver 1140 comprises three or more portions—an initial liftportion 1143 configured to be engaged by the initial contact ramp 1151of the sled 1150 as the sled 1150 travels distally through the cartridgebody—a bottom surface 1145 configured to be engaged by the intermediatecontact surface 1153 and the final contact ramp 1155 of the sled1150—and a top, or staple support, surface 1141. After the initial liftportion 1143 is engaged by the contact ramp 1151 of the sled 1150, thestaple drivers 1140 are contacted by the intermediate contact surface1153 and then the final contact ramp 1155 of the sled 1150. The finalcontact ramp 1155 of the sled 1150 is configured to drive the stapledrivers 1140 such that the top surface 1141 is driven above thecartridge deck surface 1113. Lifting the top surface 1141 of the stapledrivers 1140 beyond the cartridge deck 1113 permits the staple drivers1140 to lift the adjunct 1130 and/or tissue T away from the cartridgedeck surface 1113. More specifically, lifting the top surface 1141 ofthe staple drivers 1140 beyond the cartridge deck 1113 encourages thedetachment of attachment portions 1131 of the adjunct 1130 from thecartridge deck 1113.

Further to the above, the attachment portions 1131 are attached to thecartridge deck 1113 intermediate the staple cavities 1111 defined in thedeck 1113. During the longitudinal progression of the firing assembly,the adjunct 1130 is disengaged from the cartridge body at the attachmentportions 1131. The attachment portions 1131 are configured toprogressively release corresponding portions of the adjunct 1130 fromthe cartridge body one attachment portion 1131 at a time. Morespecifically, as a driver 1140 is lifted above the cartridge deck 1113through a staple cavity opening, as discussed above, the attachmentportions 1131 adjacent the staple cavity opening are released therebyreleasing a corresponding portion of the adjunct 1130 from the cartridgedeck 1113 while the attachment portions 1131 positioned distal to thedetached attachment portions 1131 retain the adjunct 1130 against thecartridge deck 1113 until the subsequent drivers 1140 are lifted abovethe cartridge deck 1113.

In many instances, all of the staples stored in a staple cartridge aredeployed from the staple cartridge. In such instances, the adjunct 1130is entirely released from the deck 1113 by the staples during the firingprocess. In other instances, however, a surgeon may elect to not fireall of the staples from the staple cartridge. In such instances, theremaining adjunct that has not been stapled to the tissue remainsattached to the cartridge deck 1113. The portion of the adjunct that hasnot been stapled to the tissue can be easily torn, or separated, fromthe portion of the adjunct that has been stapled to the tissue. Theportion of the adjunct that has not been stapled to the tissue remainsattached to the cartridge to limit, or eliminate, the amount ofunstapled adjunct left in the patient. In various instances, the adjunct1130 tears proximal of the last driver lifted above the cartridge deck1113. In various other instances, the adjunct 1130 tears distal of thelast driver lifted above the cartridge 1113.

Further to the above, the attachment portions 1131 can be createdutilizing any suitable method. In at least one instance, a laser meltingprocess can be utilized to create the attachment portions 1131. Incertain instances, a heat staking process can be utilized to create theattachment portions 1131. In at least one instance, portions of a wovenfiber adjunct can be pre-processed with discrete laser melting such thatthe fibers become sticky in the attachment portions 1131. Regardless ofthe manner used to create the attachment portions 1131, the adjunct 1130can be held tightly over the staple cavities such that sufficienttension, shear, and/or pealing forces are applied to the attachmentportions 1131 to detach the adjunct 1130 from the deck 1113.

A surgical stapling assembly 1200 is depicted in FIGS. 39 and 40. Thesurgical stapling assembly 1200 comprises an anvil 1260, a staplecartridge assembly 1210, and an implantable adjunct 1230. The staplecartridge assembly 1210 comprises a cartridge body comprising aplurality of staple cavities 1211 and a deck surface 1213, a pluralityof staples 1220 removably stored within the staple cavities 1211, and aplurality of staple drivers 1240 configured to drive the staples 1220out of the staple cavities 1211 and toward the anvil 1260 of thesurgical stapling assembly 1200. The staple cartridge assembly 1210 alsocomprises a sled 1250 configured to convert the linear motion of thefiring assembly into vertical motion of the staple drivers 1240 to drivethe staples 1220 out of the staple cavities 1211. The sled 1250comprises an initial contact ramp 1251 and a final contact ramp 1253configured to contact the staple drivers 1240 as the firing assemblydrives the sled 1250 from a proximal end of the cartridge assembly 1210to a distal end of the cartridge assembly 1210.

The staple drivers 1240 comprise, one, initial lift portions 1243configured to be engaged by the initial contact ramp 1251 of the sled1250 as the sled 1250 travels distally through the cartridge body toinitiate lifting of the drivers 1243, two, bottom surfaces 1245configured to be engaged by the final contact ramp 1253 of the sled 1250and, three, a top, or staple support, surface 1241. The legs of thestaples 1220 are biased against the sidewalls of the staple cavities1211 to hold the staples 1220 in the staple cavities 1211. The legs ofthe staples 1220 comprise staple tips 1221 having a barbed configurationconfigured to releasably retain, or hold, the adjunct 1230 to thecartridge body. As a result, the adjunct 1230 is held to the cartridgedeck 1213 by the staple tips 1221 of a staple 1220 until the staple 1220is driven out of the staple cavity 1211. As the staple 1220 is drivenout of the staple cavity 1211, and owing to the interaction between thebarbs, the adjunct 1230 is able to travel with the staple 1220 as thestaple tips 1221 are moved toward the anvil 1260. The barbedconfiguration of the staple tips 1221 permit a progressive release ofthe adjunct 1230 from the cartridge deck 1213.

The staple tips 1221 are configured to progressively release the adjunct1230 from the cartridge deck 1213 in a manner similar to those discussedabove. As a proximal staple 1220 is ejected from the cartridge body, adistal staple 1220 retains the adjunct 1230 against the cartridge deck1213. In the event that a clinician decides to remove the surgicalstapling instrument from the stapling site after only partially firingthe staple cartridge, the remaining adjunct that has not been stapled tothe tissue remains attached to the cartridge deck 1213. The portion ofthe adjunct that has not been stapled to the tissue can be torn, orseparated, from the portion of the adjunct that has been stapled to thetissue. The portion of the adjunct that has not been stapled to thetissue remains attached to the cartridge to limit, or eliminate, theamount of unstapled adjunct left in the patient. In various instances,the adjunct 1230 can comprise perforations, or discontinuities, forexample, configured to permit tearing of the adjunct 1230 withoutdifficulty. The perforations can be positioned between each staplecavity 1211, for example.

Further to the above, a staple leg of a staple 1220, for example, canhave a first set of barbs configured to engage the adjunct 1230 when thestaple 1220 is in its unfired position. As the staple 1220 is beingfired, the first set of barbs can exit the adjunct 1230. As the firstset of barbs exit the adjunct 1230, a second set of barbs can enter intothe adjunct 1230. The second set of barbs can be engaged with theadjunct 1230 when the staple 1220 is in its fired position. In at leastone instance, the first set of barbs can comprise two barbs while thesecond set of barbs can comprise two barbs, for example. Regardless ofthe number of barbs that are used, the first set of barbs can bepositioned above the deck 1213 of the cartridge body when the staples1220 are in their unfired position while the second set of barbs can bepositioned below the top surface of the deck 1213 when the staples 1220are in their unfired position.

As illustrated in FIG. 40, the barbs extend laterally outwardly;however, the barbs can extend in any suitable direction, such aslaterally inwardly, for example. In addition to or in lieu of the above,a staple leg can comprise tip portions which extend inwardly to grip anadjunct.

A staple cartridge assembly 1300 is depicted in FIG. 41. The staplecartridge assembly 1300, configured for use with a surgical staplinginstrument, comprises an implantable adjunct, or material, 1310 and astaple cartridge body 1301. The staple cartridge comprises a pluralityof deck features such as staple cavities 1303 configured to removablystore a plurality of staples therein and, in addition, a slot 1305configured to receive a firing assembly therethrough. The implantableadjunct 1310 is attached, secured, and/or affixed to the cartridge body1301 by thermoforming. For example, the cartridge body 1301 is heated toa specific temperature and then the implantable adjunct 1310 is pressedonto, into, and/or against the cartridge body 1301. Upon engagement withthe cartridge body 1301, the implantable adjunct 1310 forms, or molds,into the deck features of the cartridge body 1301 providing attachmentfeatures 1311 configured to permit the progressive release of theadjunct 1310 from the cartridge body 1301. Similarly, a portion 1315 ofthe adjunct 1310 can conform to the configuration of the slot 1305. Theportion 1315 can extend along the entirety of the slot 1305 or a portionof the slot 1305. In at least one instance, the portion 1315 is onlypositioned at the proximal end of the slot 1305, for example. Oneadvantage of the staple cartridge assembly 1300 may include having animplantable adjunct with a more complex shape which custom fits with acorresponding staple cartridge while sustaining a simpler manufacturingprocess, for example.

In at least one embodiment, further to the above, the staples can beloaded into the cartridge body 1301 to form a sub-assembly which is thenheated to a temperature above, at, or close to the glass transitiontemperature of the material, or materials, comprising the adjunct 1310.In at least one instance, the sub-assembly is heated to about 105degrees Celsius, for example. The adjunct 1310 is then placed over thecartridge body 1301. At this point, the adjunct 1310 is unheated, or atroom temperature; however, it is contemplated that the adjunct 1310could be pre-heated. The adjunct 1310 is then pushed downwardly onto thecartridge body 1301 and, as a result, the cartridge body 1301 heats theadjunct 1310 to a temperature which is above, at, or close to the glasstransition temperature of the material, or materials, comprising theadjunct 1310. In at least one instance, the adjunct 1310 is a foamcomprised of PGA and/or PLA, for example. Owing to the fact that thefoam is heated to a temperature above, at, or slightly below the glasstransition temperature of the PGA and/or PLA, the foam can take a newpermanent shape around the features of the cartridge body 1301 and/orthe staples positioned therein. For instance, the cartridge body 1301can include projections extending from the deck and, when the adjunct1310 is pushed onto the heated deck projections, the adjunct 1310 can bepermanently deformed around the deck projections. In such instances, theadjunct 1310 tightly grips the deck projections until the adjunct 1310is pushed off of the projections by the staples. Similarly, the adjunct1310 can permanently deform around and tightly grip the heated staplelegs. In at least one instance, the diameter of the newly-formed holescan be about 10% smaller than the diameter of the staple legs, forexample. In any event, the pressure applied to the adjunct 1310 can beremoved at any suitable time. In at least one instance, the pressure isapplied to the adjunct 1310 until the temperature of the cartridge body1301, the staples, and the adjunct 1310 is well below, or at leastbelow, the glass transition temperature of the materials comprising theadjunct 1310. Alternatively, the pressure can be removed when thetemperature of the staple cartridge assembly 1300 is at or above theglass transition temperature of the materials comprising the adjunct1310.

FIGS. 42-44 depict yet another surgical stapling assembly 1400. Thesurgical stapling assembly 1400 comprises an anvil 1460, a staplecartridge assembly 1410, and an implantable adjunct 1430. The staplecartridge assembly 1410 comprises a cartridge body comprising aplurality of staple cavities 1411, a deck surface 1413, and a slot 1415.The staple cartridge assembly 1410 further comprises a plurality ofstaples 1420 removably stored within the staple cavities 1411, and aplurality of staple drivers 1440 configured to drive the staples 1420out of the staple cavities 1411 toward the anvil 1460 of the surgicalstapling assembly 1400. The staple cartridge assembly 1410 alsocomprises a sled 1450 configured to convert the linear motion of afiring assembly into vertical motion of the staple drivers 1440 to drivethe staples 1420 out of the staple cavities 1411. The sled 1450comprises driver ramps 1451 configured to contact and drive the stapledrivers 1440 toward the anvil 1460 and, in addition, a release portion1453 configured to detach the adjunct 1430 from the deck 1413.

The release portion 1453 comprises lateral flanges which extend over aportion of the deck surface 1413. More specifically, the lateral flangesextend over the deck surface 1413 between the slot 1415 and the innerrows of staple cavities 1411. The adjunct 1430 comprises attachmentportions 1431 configured to releasably hold the adjunct 1430 to thecartridge deck 1413 until the release portion 1453 of the sled 1450engages the attachment portions 1431. As the firing assembly progressesthrough the staple cartridge assembly 1410, the release portion 1453 canact as a plow, for example, configured to plow, cut, incise, and/orslice the attachment portions 1431 as the release portion 1453 engagesthe attachment portions 1431. The attachment portions 1431 are engagedprogressively as the firing assembly traverses the cartridge body fromits proximal end toward its distal end.

Turning now to FIG. 45, a staple cartridge assembly 1500 is depicted.The staple cartridge assembly 1500 comprises a cartridge body 1510comprising a cartridge deck 1513, attachment features 1515, deckfeatures 1517, and a slot 1519. The staple cartridge assembly 1500further comprises a plurality of staples 1520 and an implantable adjunct1530 releasably held to the cartridge deck 1513 by the attachmentfeatures 1515. The deck features 1517 guide the staples 1520 as thestaples 1520 are ejected from the staple cartridge 1510. The deckfeatures 1517 also limit movement of the adjunct 1530 during clampingand/or cutting of the tissue captured by the surgical instrumentemploying the staple cartridge assembly 1500.

The attachment features 1515 comprise barbs, for example. Each barb 1515comprises a sharp tip configured to puncture the adjunct 1530 and aretention shoulder configured to inhibit the barb 1515 from backing outof the adjunct 1530. The barbs 1515 can extend from the deck 1513 at anysuitable location. For instance, the barbs 1515 can be arranged inlongitudinal rows on opposite sides of the cartridge body 1510. In suchinstances, the adjunct 1530 can be held between the longitudinal rows ofbarbs 1515. The adjunct 1530 can be held taut, tensioned, or stretchedbetween the rows of barbs 1515 which can facilitate the transection ofthe adjunct 1530 by a cutting member of a firing assembly passingthrough the longitudinal slot 1519. As the cutting member transects theadjunct 1530, the tension within the adjunct 1530 is released. Moreover,the transected portions of the adjunct 1530 may move, or migrate,laterally outwardly away from the longitudinal slot 1519 in response tothe release of the tension within the adjunct 1530. Such movement of thetransected adjunct portions may cause the transected adjunct portions toat least partially detach from the barbs 1515. In at least one instance,the retention shoulders of the barbs 1515 face laterally outwardly suchthat the lateral outward movement of the adjunct portions tends torelease the adjunct portions from the barbs 1515.

As discussed above, an adjunct can be manufactured and then assembled toa staple cartridge. Turning now to FIGS. 46-48, a staple cartridgeassembly 1600 comprises a cartridge body 1610 including staple cavities1611 and a longitudinal slot 1613 defined therein. The staple cartridgeassembly 1600 further comprises an implantable adjunct which ismanufactured directly on the cartridge body 1610. As illustrated in FIG.46, an implantable material 1630 can be dispensed on the deck of thecartridge body 1610. In various instances, the implantable material cancomprise melt-blown non-woven material, for example. Such an instance isdepicted in FIG. 47, for example. In at least one embodiment,electro-spinning is utilized to melt and blow a polymeric material ontothe cartridge body 1610. In at least one such embodiment, the polymericmaterial is heated to a temperature which exceeds the glass transitiontemperature of the polymeric material, for example. In certainembodiments, the polymeric material is part of a solution. In eitherevent, the polymeric material is flowable and is accelerated toward thecartridge body 1610. The polymeric material is accelerated by amechanical spinning member, such as a spinneret, for example, and/oraccelerated by applying a voltage differential between the polymericmaterial and a target. In various instances, the polymeric material iselectrically charged. In at least one instance, the polymeric materialcomprises one or more magnetic materials embedded therein. The targetcan comprise the cartridge body 1610 and/or a metal plate positionedbehind the cartridge body 1610, for example.

In some instances, further to the above, the melt-blown non-wovenmaterial extends over the edges of the cartridge body 1610 after it hasbeen dispensed on the cartridge body 1610. Such excess material,referring to FIG. 48, can be trimmed such that the edges of the material1630 are aligned with, or substantially aligned with, the edges of thecartridge body 1610. Such trimming can occur once the temperature of themelt-blown non-woven material has sufficiently cooled.

Further to the above, melt-blown non-woven material can be used tomanufacture an implantable adjunct which is not formed directly on acartridge body. In at least one such instance, a polymeric material isheated and blown into a cavity, or mold, to form an implantable adjunct.After the polymeric material has sufficiently cooled, the polymericmaterial can be trimmed to a suitable size. In addition to or in lieu ofthe above, a melt-blown non-woven material can be applied to a cartridgebody to adhere an implantable adjunct to the cartridge body. In suchinstances, the adjunct can be pressed onto the melt-blown non-wovenmaterial while the material is still at least partially melted, forexample.

Turning now to FIG. 49, a staple cartridge assembly 2000 comprises acartridge body 2010 and an implantable layer 2030. The cartridge body2010 comprises a deck 2011 and a plurality of staple cavities 2012defined in the deck 2011. The layer 2030 is adjacent the deck 2011 andextends over the staple cavities 2012. A staple 2020 is removablypositioned in each staple cavity 2012. Each staple 2020 is movable froman unfired position to a fired position by a firing member and/or stapledriver system. As illustrated in FIG. 49, the tips 2021 of the staples2020 extend above the deck 2011 and are partially embedded in the layer2030 when the staples 2020 are in their unfired position; however, otherembodiments are envisioned in which the tips 2021 do not extend abovethe deck 2011 and are not embedded in the layer 2030. When the staples2020 are ejected from the staple cavities 2012, the staples 2020 captureportions of the layer 2030 therein and implant the layer 2030 againstthe patient tissue T, as illustrated in FIG. 50.

The layer 2030 is comprised of a plurality of first fibers and aplurality of second fibers. The first fibers are comprised of a firstmaterial and the second fibers are comprised of a second material whichis different than the first material. The first material has a firstthermal transition temperature in which the first material changesstates. The second material has a second thermal transition temperaturein which the second material changes states. In at least one instance,the first material has a first glass transition temperature and thesecond material has a second glass transition temperature which isdifferent than the first glass transition temperature. When the firstmaterial exceeds its glass transition temperature, the first fibers willcontract. Similarly, the second fibers will contract when the secondmaterial exceeds its glass transition temperature. A contraction of afiber comprises a shortening of its longest length. More specifically, afiber often comprises a strand which has a curved and/or twisted shapeand, when the strand is heated above its glass transition temperature,the shape of the strand will tend to become more curved and/or twistedwhich shortens its longest length even though the overall length of thestrand has not changed. In such instances, the configuration of thefibers will become less organized.

The first fibers and the second fibers of the layer 2030 can be mixedutilizing any suitable process. In at least one process, the firstfibers and the second fibers can be interwoven, for example. Forinstance, the first fibers can be woven into a mesh and the secondfibers can be interwoven into the mesh. After the fibers have beensuitably mixed, the fibers can be exposed to heat. The fibers are heatedto a temperature above the first thermal transition temperature butbelow the second thermal transition temperature. As a result, the firstfibers contract and the second fibers do not contract, or at least theydo not substantially contract. Nonetheless, the contraction of the firstfibers will constrict the second fibers and change the overall shape ofthe layer 2030. More specifically, the contracting first fibers willpull the edges of the layer 2030 inwardly. Such inward movement of theedges can increase the thickness 2031 of the layer 2030. In certaininstances, the layer will become puffy and/or bunch up. In any event,the heating processes described herein can allow a layer 2030 to assumea configuration which can compensate for variations of the tissuethickness captured in the staples.

The first and second materials of the layer 2030 can comprise anysuitable materials. For example, the first material is a first polymerand the second material is a second polymer. For instance, the firstmaterial is polydioxanone (PDS) and the second material is polyglycolicacid (PGA), such as VICRYL manufactured by Ethicon, Inc., for example.The layer 2030 comprises more of the second material having a higherthermal transition temperature than the first material having a lowerthermal transition temperature. In at least one example, the ratio ofVICRYL, i.e., the second material, to PDS, i.e., the first material, isapproximately 7:1. In at least one other example, the ratio of VICRYL,i.e., the second material, to PDS, i.e., the first material, isapproximately 5:1. Other ratios and materials are possible.

Further to the above, various alternative embodiments are envisioned inwhich the layer 2030 is heated to a processing temperature such that thefirst fibers are heated above their thermal transition temperature andthe second fibers are also heated above their thermal transitiontemperature. In at least one such instance where the first thermaltransition temperature is below the second thermal transitiontemperature, the first fibers will contract more than the second fibers.

After the layer 2030 has been heated to achieve its desirable propertiesas described herein, the layer 2030 is cooled and/or permitted to coolbelow the first thermal transition temperature and the second thermaltransition temperature. The layer 2030 is cooled below the first andsecond thermal transition temperatures before being assembled to thecartridge body 2010.

In various alternative embodiments, turning now to FIG. 57, a layer 2330of a staple cartridge assembly 2300 is heated to a temperature that isabove at least one of the first thermal transition temperature and thesecond thermal transition temperature and then positioned and/or pressedagainst a cartridge body 2310 of the cartridge assembly 2300. The layer2330 is then cooled and/or permitted to cool.

Further to the above, the cartridge body 2310 comprises a deck 2311 andstaple cavities 2312 defined in the deck 2311. The cartridge body 2310further comprises posts 2315 extending upwardly from the deck 2311. Whenthe heated layer 2330 is pressed against the deck 2311, the layer 2330can conform to the features of the cartridge body 2310. For instance,portions of the layer 2330 can be wedged into the staple cavities 2312and can assume the shape of the staple cavities 2312 to form projections2332. Similarly, portions of the layer 2330 can form around the posts2315 and assume the shape of the posts 2315 to form apertures 2335.Also, similarly, portions of the layer 2330 can be wedged into alongitudinal knife slot 2314 of the cartridge body 2310 to form tabs2334.

Further to the above, the initial alignment between the heated layer2330 and the cartridge body 2310 will determine how the features areformed on the bottom of the layer 2330. The cartridge body 2310comprises one or more datums which can assist in the proper alignmentbetween the layer 2330 and the cartridge body 2310. The cartridge body2310 comprises alignment stops 2318 extending upwardly from the proximalend of the cartridge body 2310 which can be utilized to align theproximal end 2338 of the layer 2330 with the proximal end of thecartridge body 2310.

Turning now to FIG. 52, a first fiber 2231 and a second fiber 2232 areintertwined or interwoven. When the fibers 2231 and 2232 are exposed toheat, Q, the first fiber 2231 becomes less disorganized and begins tocontract along its longest dimension, as illustrated in FIG. 52. As alsoillustrated in FIG. 52, the first fiber 2231 contracts relative to thesecond fiber 2232. While the first fiber 2231 contracts in its longestdimension, referring to FIG. 53, the first fiber 2231 expands in alateral direction. As a result, the assembly of fibers 2231, 2232 canbecome resilient and can change shape under load.

The arrangement of the fibers 2231 and 2232 within a layer can berandom. In certain instances, the arrangement of the fibers 2231 and2232 within a layer can be at least partially organized. Turning now toFIG. 55, a layer 2230 comprises a mesh of second fibers 2232. The secondfibers 2232 are attached, or interwoven, to one another at nodes 2235;however, various embodiments are envisioned in which the second fibers2232 are not attached to each other. The second fibers 2232 are arrangedin a lattice, or network, which extends along longitudinal axes 2233 andlateral axes 2234. The axes 2233 and 2234 are orthogonal, orsubstantially orthogonal, to each other; however, other embodiments areenvisioned in which the lattice of second fibers 2232 are not arrangedalong an organized array of axes. The first fibers 2231 are interwoveninto the mesh of the second fibers 2232. When the layer 2230 is exposedto a temperature which exceeds the first thermal transition temperatureof the first material, the first fibers 2231 contract, as illustrated inFIG. 56. As a result, the layer 2230 assumes a laterally expandedconfiguration, referenced as layer 2230′.

Turning now to FIG. 51, a layer assembly 2130 comprises a first layer2131, a second layer 2132, and a third layer 2133. The first layer 2131comprises a plurality of first fibers 2134 interwoven with a pluralityof second fibers 2135. Similarly, the third layer 2133 comprises aplurality of first fibers 2134 interwoven with a plurality of secondfibers 2135. Similar to the above, the first fibers 2134 are comprisedof a first material having a first thermal transition temperature andthe second fibers 2135 are comprised of a second material having asecond thermal transition temperature which is different than the firstthermal transition temperature. The second layer 2132 is positionedintermediate the first layer 2131 and the third layer 2133. The secondlayer 2132 is comprised of a film; however, any suitable material couldbe utilized. The first layer 2131 and the third layer 2133 can beattached to the second layer 2132 utilizing one or more adhesives, forexample. The second layer 2132 separates the first layer 2131 from thethird layer 2133. In various instances, the second layer 2132 can permitthe first layer 2131 and the third layer 2133 to be constrictedindependently of one another.

In various instances, further to the above, portions of a layer can beremoved and/or modified utilizing any suitable process. Referring againto FIG. 57, one or more longitudinal slits 2337 can be created in thelayer 2330 utilizing a laser cutting process, for example. Bridges 2336are defined intermediate the slits 2337 and hold the two lateral halvesof the layer 2330 together.

Turning now to FIG. 58, an end effector assembly 2400 comprises a staplecartridge body 2410 and an anvil 2490. The cartridge body 2410 comprisesa deck 2411, a longitudinal knife slot 2414, and longitudinal rows ofstaple cavities defined on opposite sides of the slot 2414. Moreparticularly, a first longitudinal row of staple cavities 2412 a isdisposed on each side of the longitudinal slot 2414, a secondlongitudinal row of staple cavities 2412 b is disposed laterallyrelative to each first row of staple cavities 2412 a, and a thirdlongitudinal row of staple cavities 2412 c is disposed laterallyrelative to each second row of staple cavities 2412 b. A first staple2020 a is removably stored in each first staple cavity 2412 a, a secondstaple 2020 b is removably stored in each second staple cavity 2412 b,and a third staple 2020 c is removably stored in each third staplecavity 2412 c.

Further to the above, the first staples 2020 a each have a firstunformed height, the second staples 2020 b each have a second unformedheight, and the third staples 2020 c each have a third unformed height.The first unformed height is shorter than the second unformed height andthe second unformed height is shorter than the third unformed height.Other embodiments are envisioned in which the first staples 2020 a, thesecond staples 2020 b, and/or the third staples 2020 c have the sameunformed height. U.S. Pat. No. 8,317,070, entitled SURGICAL STAPLINGDEVICES THAT PRODUCE FORMED STAPLES HAVING DIFFERENT LENGTHS, whichissued on Nov. 27, 2012, is incorporated herein by reference in itsentirety. The anvil 2490 comprises a first longitudinal row of formingpockets 2492 a aligned with the staple cavities 2412 a, a secondlongitudinal row of forming pockets 2492 b aligned with the staplecavities 2412 b, and a third longitudinal row of forming pockets 2492 caligned with the staple cavities 2412 c. The staples 2020 a, 2020 b, and2020 c are ejected from the staple cavities 2412 a, 2412 b, and 2412 cby a plurality of staple drivers positioned in the cartridge body 2410which lift the staples 2020 a, 2020 b, and 2020 c into contact with theforming pockets 2492 a, 2492 b, and 2492 c, respectively.

Further to the above, the staple drivers positioned in the cartridgebody 2410 and the forming pockets 2492 a, 2492 b, and 2492 c of theanvil 2490 are configured to deform the staples 2020 a, 2020 b, and 2020c to different formed heights. More specifically, the first staples 2020a are deformed to a first formed height, the second staples 2020 b aredeformed to a second formed height which is taller than the first formedheight, and the third staples 2020 c are deformed to a third formedheight which is taller than the second formed height. FIG. 59illustrates such an arrangement. Other embodiments are envisioned inwhich the third formed height is the same as the second formed height.

Further to the above, referring again to FIG. 58, the deck 2411 of thecartridge body 2410 comprises a sloped support surface. The portion ofthe deck 2411 extending along the first longitudinal row of staplecavities 2412 a is higher than the portion of the deck 2411 extendingalong the second longitudinal row of staple cavities 2412 b. Similarly,the portion of the deck 2411 extending along the second longitudinal rowof staple cavities 2412 b is higher than the portion of the deck 2411extending along the third longitudinal row of staple cavities 2412 c.The deck 2411 comprises an arcuate surface. In various instances, thesloped support surface of the deck 2411 can include discrete steppedsurfaces. For instance, the deck 2411 can include a first longitudinalstep which extends along the first row of staple cavities 2412 a, asecond longitudinal step which extends along the second row of staplecavities 2412 b, and/or a third longitudinal step which extends alongthe third row of staple cavities 2412 c. The deck 2411 can furtherinclude sloped surfaces intermediate the first step and the second stepand/or intermediate the second step and the third step.

Further to the above, the anvil 2490 includes a stepped tissuecompression surface. For instance, the third longitudinal rows offorming pockets 2492 c are defined in longitudinal steps. In alternativeembodiments, the anvil 2490 comprises a flat tissue compression surface.In either event, tissue positioned between the cartridge body 2410 andthe anvil 2490 is compressed to a suitable pressure therebetween whenthe end effector 2400 is in a clamped configuration, as illustrated inFIG. 58. Such tissue compression, however, is not uniform within the endeffector 2400. For instance, the tissue adjacent the first row of staplecavities 2412 a is compressed to a first pressure, the tissue adjacentthe second row of staple cavities 2412 b is compressed to a secondpressure which is less than the first pressure, and the tissue adjacentthe third row of staple cavities is compressed to a third pressure whichis less than the second pressure. Other arrangements are contemplated.

The end effector 2400 further comprises implantable layers 2430positioned over the deck 2411. For instance, a first layer 2430 ispositioned on a first side of the longitudinal slot 2414 and a secondlayer 2430 is positioned on a second side of the longitudinal slot 2414.The layers 2430 define a longitudinal slot therebetween which isaligned, or at least substantially aligned, with the slot 2414 definedin the cartridge body 2410 and a longitudinal slot 2494 defined in theanvil 2490. The cartridge slot 2414, the layer slot, and the anvil slot2494 are configured to permit a firing member to move longitudinallythrough the end effector 2400. In alternative embodiments, a layerpositioned on the deck 2411 does not comprise a layer slot and a cuttingportion of the firing member transects the layer as the firing member ismoved distally.

The implantable layers described herein can be comprised of fibers whichare interwoven together. Fibers 3000, for example, are illustrated inFIGS. 60 and 61. Each fiber 3000 comprises a strand which has beenplastically deformed and includes one or more kinks defined therein. Animplantable layer, such as layer 3030 illustrated in FIG. 63, forexample, that comprises fibers 3000 is resilient and can compensate forvariations in tissue thickness captured within staples 3020. The fibers3000 are woven together to form an implantable layer which can act as acollective spring. Moreover, the fibers 3000 of the layer 3030 are softas a result of their kinked configuration and are less likely to abradetissue T as compared to previous implantable layers that do not includethe fibers 3000, such as the layer 3130 depicted in FIG. 62, forexample.

The fibers 3000 can be manufactured in any suitable manner. In variousinstances, a manufacturing process can utilize any suitable means formechanically and/or thermally creating kinks in the fibers 3000 and/orotherwise plastically deforming the fibers 3000. Turning now to FIG. 65,a heated die can be utilized to plastically deform a strand 3000′ toform a continuous fiber 3000. The heated die comprises first and secondsides 3050 wherein at least one of the sides is movable relative to theother side between an open position and a closed position. FIG. 65illustrates the heated die in an open configuration. When the die is inits open configuration, a portion of the unformed strand 3000′ ispositioned in the die between the open sides 3050. In at least oneinstance, the manufacturing process includes a spool 3060 configured topull the strand 3000′ into the die. Each side 3050 of the die includes aheated surface 3051. The heated surfaces 3051 include a plurality ofprojections which are configured to contact the strand 3000′ and,through mechanical pressure and/or heating, plastically deform thestrand 3000′. At such point, the continuous strand 3000′ becomes acontinuous fiber 3000 which is wrapped around the spool 3060. Thecontinuous fiber 3000 can be transected during a subsequent step in themanufacturing process, if desired.

Further to the above, turning now to FIG. 66, a manufacturing processincludes one or more rotatable dies 3350. Each die 3350 is rotatableabout an axis 3352 and includes a plurality of teeth 3351 extendingaround the die 3350. The teeth 3351 of the rotatable dies 3350 areintermeshed and deform the continuous strand 3000′ into the continuousfiber 3000 when the strand 3000′ passes through the intermeshed teeth3351. Similar to the above, the dies 3350 are heated and apply heat (Q)to the strand 3000′. Turning now to FIG. 67, a manufacturing processincludes a rotatable die 3450. The die 3450 is rotatable about an axis3452 and includes teeth 3451 extending therefrom. A continuous strand3000′ is wrapped around the perimeter of the die 3450 and is engagedwith the teeth 3451. The teeth 3451 are heated and, when the teeth 3451contact the strand 3000′, the strand 3000′ becomes a continuous kinkedfiber 3000. A tensile force can be applied to the fiber 3000 to pull thefiber 3000 around the die 3450.

In addition to or in lieu of the above, the fibers 3000 can be deformed,or kinked, in any suitable manner. In various instances, air texturingand/or any other suitable form of texturing could be used, for example.Moreover, the intervals between the deformations, or kinks, in thefibers 3000 can be utilized to control the properties of the fibers3000. Fibers 3000 having shorter intervals between the deformations, orkinks, will be less stiff than fibers 3000 having longer intervalsbetween the deformations, or kinks. Regardless of the manner ofdeformation used to deform the fibers 3000, the fibers 3000 can compriseany suitable cross-section. In at least one instance, the strands 3000′can comprise a circular, or an at least substantially circular,cross-section which is at least partially flattened after the strands3000′ have been deformed, or kinked to form the fibers 3000. In variousinstances, the fibers 3000 have an oblate cross-section where they havebeen deformed, for example.

Further to the above, the fibers 3000 can undergo a deformation, orkinking process, during one or more steps of a manufacturing process toform an implantable layer. In at least one process, the fibers 3000 aredeformed, or kinked, before they are weaved together in a preliminaryweaving process. Such a deformation process can utilize pressure and/orheat, for example. Alternatively, the fibers do not undergo adeformation process before the preliminary weaving process. In eitherevent, once the fibers 3000 have been woven together, they are unwoven.The process of weaving and then unweaving the fibers 3000 deforms, orkinks, the fibers 3000. After the fibers 3000 have been unwoven, theymay or may not undergo a deformation, or kinking, process. Such adeformation process can utilize pressure and/or heat, for example. Afterthe fibers 3000 have undergone a suitable number of pre-kinkingprocesses, the fibers 3000 are then re-woven into an implantable layer.

In various instances, further to the above, only the pre-kinked fibers3000 are utilized to weave an implantable layer while, in otherinstances, the pre-kinked fibers 3000 are mixed with other fibers, suchas unkinked fibers, for example. In at least one instance, a wovenimplantable layer comprises a first group of pre-kinked fibers 3000comprised of a material and a second group of unkinked fibers comprisedof the same material. In another instance, a woven implantable layercomprises a first group of pre-kinked fibers 3000 comprised of a firstmaterial and a second group of unkinked fibers comprised of a secondmaterial which is different than the first material. In yet anotherinstance, a woven implantable layer comprises a first group ofpre-kinked fibers 3000 which are kinked at a first interval and a secondgroup of pre-kinked fibers which are kinked at a second interval whichis different than the first interval. Implantable layers comprised of afirst group of fibers having a higher stiffness interwoven with a secondgroup of fibers having a higher stiffness, such as those describedherein, for example, can provide the implantable layer with a desiredmodulus of elasticity.

The deformed, or kinked, fibers described herein can be woven into animplantable layer in any suitable manner. In various instances, animplantable layer can be woven such that it does not comprise seams.Turning now to FIG. 68, an implantable layer 3530 can be woven, orknitted, such that it comprises seams. The implantable layer 3530comprises a top surface 3531, a bottom surface 3532, and interwovenfibers which are connected to each other along lateral seams 3533,longitudinal seams 3534, and internal seams 3535. Referring to FIG. 69,the layer 3530 is comprised of fibers 3000 and, in addition, fibers3500. Referring to FIG. 70, the fibers 3000 and 3500 are interwoven toform the seams 3533, 3534, and 3535.

The seams 3533, 3534, and 3535 can be interwoven at a desired density toachieve a desired result. For instance, the density of the longitudinalseams 3534 is higher on the lateral sides of the layer 3530 than in themiddle of the layer 3530. The middle of the layer 3530 is aligned with acutting member of the stapling instrument when the layer 3530 ispositioned on a staple cartridge and inserted into the staplinginstrument. Owing to the lower density in the middle of the layer 3530being aligned with the cutting member, the layer 3530 can be more easilytransected by the cutting member while permitting the layer 3530 to havea different density in the regions which are captured by the staples.Also, for instance, the density of the lateral seams 3533 is higher inthe middle of the layer 3530 than at the proximal and distal ends of thelayer 3530. Owing to the lower density at the proximal end of the layer3530, the cutting member can more easily begin its transection of thelayer 3530. Similarly, the lower density at the distal end of the layer3530 can assist the cutting member in finishing its cut as the cuttingmember slows down at the end of its stroke.

A layer 3230 is illustrated in FIG. 64. The layer 3230 comprises a topportion 3231, a bottom portion 3232, and an intermediate portion 3233connecting the top portion 3231 and the bottom portion 3232. Theintermediate portion 3233 spaces and positions the top portion 3231relative to the bottom portion 3232. The portions 3231, 3232, and 3233are comprised of kinked fibers 3000. The fibers 3000 are organized, orweaved, into lateral seams 3233 and longitudinal seams 3234. The densityof the longitudinal seams 3234 is higher in the medial portion of thelayer 3230 as compared to the lateral portions of the layer 3230.

Further to the above, turning now to FIGS. 71 and 72, a staple cartridge3600 includes a cartridge body 3610 and an implantable layer 3630. Thecartridge body 3610 comprises a deck 3611 configured to support thelayer 3630. The layer 3630 comprises a top surface 3631, a bottomsurface 3632, and is comprised of fibers 3633. The density 3634 of thefibers 3633 is higher in the middle of the layer 3630 than the lateralsides of the layer 3630. In fact, the higher density 3634 of the fibers3633 is aligned with a longitudinal slot 3614 defined in the cartridgebody 3610 which is configured to receive a cutting portion of the firingmember. The higher density 3634 of the fibers 3633 in the middle of thelayer 3630 can reduce buckling or movement of the layer 3630 relative tothe cartridge body 3610.

Turning now to FIG. 73, an implantable layer 3730 comprises a topsurface 3731, a bottom surface 3732, and a body comprised of interwovenfibers. The fibers are interwoven into lateral seams 3733 andlongitudinal seams 3734. The fibers are interconnected to one another atweave points 3735. The weave points 3735 connect fibers that extendlaterally and/or longitudinally within the implantable layer 3730. Theweave points 3735 can connect the fibers within a lateral seam 3733. Theweave points 3735 can connect fibers within a longitudinal seam 3734.The weave points 3735 can connect the lateral seams 3733 with thelongitudinal seams 3734. The density of the weave points 3735 in theimplantable layer 3730 can control the resiliency or elasticity of theimplantable layer 3730. The portions of the layer 3730 having a higherweave point density may be less resilient than the portions of the layer3730 having a lower weave point density. With regard to the embodimentdepicted in FIG. 73, the lateral portions of the layer 3730 have a highweave point density while the medial portion of the layer 3730 has a lowweave point density; however, any suitable arrangement of weave pointdensities could be utilized.

Turning now to FIG. 74, an implantable layer 3830 comprises a topsurface 3831, a bottom surface 3832, and a body comprised of interwovenfibers. The fibers are interwoven into lateral seams 3833 andlongitudinal seams 3834. The fibers are interconnected to one another atweave points 3835. The weave points 3835 connect fibers that extendlaterally and/or longitudinally within the implantable layer 3830. Theweave points 3835 can connect the fibers within a lateral seam 3833. Theweave points 3835 can connect fibers within a longitudinal seam 3834.The weave points 3835 can connect the lateral seams 3833 with thelongitudinal seams 3834.

In various instances, further to the above, the fibers that areinterwoven into an implantable layer can have the same diameter and/orlength. In other instances, the fibers can have different diametersand/or lengths. Referring again to FIG. 74, certain fibers of theimplantable layer 3830 have a first diameter, or thickness, and otherfibers have a second diameter, or thickness, which is larger than thefirst diameter. The thinner fibers are in the center of the implantablelayer 3830 and the thicker fibers are in the lateral sides of theimplantable layer 3830. When the cutting member of the surgical staplinginstrument passes through the center of the implantable layer 3830, thethinner fibers can facilitate the cutting of the implantable layer 3830.Alternatively, the thicker fibers are in the center of the implantablelayer 3830 which can inhibit the layer 3830 from buckling.

Turning now to FIGS. 75 and 76, an implantable adjunct 4030 comprises aplurality of layers. The adjunct 4030 comprises a first outside layer4031 and a second outside layer 4035. The first outside layer 4031 iscomprised of interwoven fibers. Similarly, the second outside layer 4035is comprised of interwoven fibers. The fibers of the outside layers4031, 4035 can be comprised of any suitable material, such as VICRYLand/or any of the materials described in the present application, forexample. The adjunct 4030 further comprises a middle, or intermediate,layer 4033. The middle layer 4033 is also comprised of interwovenfibers. The middle layer 4033 can be comprised of the same materials asthe outside layers 4031, 4035 and/or different materials.

Referring again to FIGS. 75 and 76, the adjunct 4030 further comprises afirst bonding layer 4032 and a second bonding layer 4034. The firstbonding layer 4032 is positioned intermediate the first outside layer4031 and the middle layer 4033. The second bonding layer 4034 ispositioned intermediate the second outside layer 4035 and the middlelayer 4033. The first bonding layer 4032 is comprised of a material thathas a lower melt temperature than the materials comprising the layers4031, 4033, and 4035. Similarly, the second bonding layer 4034 iscomprised of a material that has a lower melt temperature than thematerials comprising the layers 4031, 4033, and 4035.

Further to the above, the layers 4031, 4032, 4033, 4034, and 4035 of theadjunct 4030 are stacked in the manner depicted in FIG. 75. The adjunct4030 is then heated. The adjunct 4030 is heated such that thetemperature of the bonding layers 4032 and 4034 equals or exceeds themelt temperature of the material comprising the bonding layers 4032 and4034. When the bonding layers 4032 and 4034 are comprised of the samematerial, the bonding layers 4032 and 4034 will melt at the sametemperature. This temperature can be referred to as the threshold melttemperature. When the first bonding layer 4032 is comprised of a firstmaterial having a first melt temperature and the second bonding layer4034 is comprised of a second material having a second, or different,melt temperature, one of the layers 4032, 4034 will begin to melt beforethe other. In such instances, the threshold melt temperature comprisesthe higher of the first and second melt temperatures.

As the bonding layers 4032, 4034 are melting, the melted materialpenetrates the first outside layer 4031, the middle layer 4033, and/orthe second layer 4035. The amount in which the melted layers 4032, 4034penetrate into the layers 4031, 4033, 4035 can be dependent on severalfactors. For example, the layers 4031, 4033, and/or 4035 can becomprised of interwoven fibers and the amount in which the melted layers4032, 4034 penetrate the fiber weaves can depend on the openness of thefiber weaves. For instance, the melted layers 4032, 4034 can penetratedeeper into a more open, or looser, weave than a more closed, ortighter, weave. Stated another way, the melted layers 4032, 4034 may notpenetrate extensively into a tightly knit weave. The first outside layer4031 and the second outside layer 4035 have the same, or at leastsubstantially the same, weave density. In various alternativeembodiments, the first outside layer 4031 and the second outside layer4035 have different weave densities. In at least one such embodiment,turning now to FIG. 77, the second outside layer 4035″ of an alternativeadjunct 4030″ has a tighter weave than the first outside layer 4031″.The first bonding layer 4032″ may penetrate deeper, or more extensively,into the first outside layer 4031″ than the second bonding layer 4034″may penetrate into the second outside layer 4035″.

Referring again to FIG. 75, the middle layer 4033 of the adjunct layer4030 comprises apertures 4036 defined therein. The apertures 4036comprise throughholes. The melted bonding layers 4032, 4034 can enterinto the apertures 4036 to improve, or increase, the bond between thebonding layers 4032, 4034 and the middle layer 4033. In alternativeembodiments, the apertures 4036 may not extend entirely through themiddle layer 4033. That said, such apertures 4036 may be sufficientlydeep to receive a sufficient quantity of melted material to form anadequate bond with the bonding layers 4032, 4034. The first outsidelayer 4031 and/or the second outside layer 4035 may include aperturesdefined therein to improve, or increase, their bond with the firstbonding layer 4032 and the second bonding layer 4034, respectively.

As discussed above, the adjunct 4030 is heated to melt, or at leastpartially melt, the bonding layers 4032, 4034. As also discussed above,the melted portions of the bonding layer 4032, 4034 flow into the layers4031, 4033, and/or 4035. After the adjunct has been sufficiently heated,the adjunct 4030 is cooled and/or is permitted to cool. The adjunct 4030can be placed in a refrigeration unit, set out in the open air, and/orexposed to a flow of air, for example. When the adjunct 4030 cools belowthe threshold melt temperature, the melted bonding layers 4032, 4034 canbegin to solidify, thereby locking the layers 4031, 4032, 4033, 4034,and 4035 together. In various instances, the melted bonding layers 4032and 4034 can assume a mechanically interlocked configuration with thelayers 4031, 4033, and 4035, as illustrated in FIG. 76.

Further to the above, the layers 4031, 4033, and 4035 of the adjunct4030 are comprised of materials having a melt temperature which isgreater than the threshold melt temperature of the bonding layers 4032and 4034. Moreover, the layers 4031, 4033, and 4035 are comprised ofmaterials having a melt temperature which is greater than the highestprocessing temperature in which the adjunct 4030 is exposed to. As aresult, the layers 4031, 4033, and 4035 will not melt while the bondinglayers 4032 and 4034 are being melted. In at least one instance, thelayers 4031, 4033, and 4035 are comprised of VICRYL, for example, andthe bonding layers 4032 and 4034 are comprised of PDS, for example. Inat least one such instance, the bonding layers 4032 and 4034 arecomprised of a PDS film, for example.

In various embodiments, further to the above, each bonding layer 4032,4034 can be comprised of two or more materials. In certain instances,each material comprising the bonding layers 4032, 4034 has a melttemperature which is equal to or below the maximum processingtemperature of the adjunct 4030. In other instances, some of thematerials comprising the bonding layers 4032, 4034 have a melttemperature equal to or below the maximum processing temperature whileothers have a melt temperature above the maximum processing temperature.In such embodiments, some portions of the layers 4032 and 4034 will meltand penetrate the adjacent layers 4032, 4033, and 4035 while otherportions of the layers 4032 and 4034 will maintain their structuralintegrity.

Further to the above, each layer 4031, 4033, and 4035 can be comprisedof two or more materials. In certain instances, each material comprisingthe layers 4031, 4033, 4035 has a melt temperature which is above themaximum processing temperature of the adjunct 4030. In other instances,some of the materials comprising the layers 4031, 4033, 4035 have a melttemperature above the maximum processing temperature while others have amelt temperature equal to or below the maximum processing temperature.In such embodiments, some portions of the layers 4031, 4033, 4035 willmelt and mix with the melted portions of the adjacent bonding layers4032, 4034 thereby improving the bond between the layers 4031, 4032,4033, 4034, and 4035 once the temperature of the adjunct 4030 has cooledbelow the melt temperature of each of the materials comprising theadjunct 4030.

The adjunct 4030 is not pressed when it is exposed to heat. The meltedmaterials of the adjunct 4030 flow in response to the natural forces,such as gravitational and/or capillary forces, for example, acting onthe melted materials; however, embodiments are envisioned in which theadjunct 4030 is pressed when it is exposed to heat. Such pressure canimprove the flow of the melted materials within the adjunct 4030 andimprove the bond between the layers 4031, 4032, 4033, 4034, and 4035.The pressure can be removed from the adjunct 4030 while the meltedportions are still flowable. Alternatively, the pressure can be removedafter the melted portions have re-solidified.

The adjunct 4030 comprises five layers; however, an adjunct employingthe principles disclosed herein may comprise any suitable number oflayers. For example, an adjunct can comprise three layers including thefirst outer layer 4031, the second outer layer 4035, and a bonding layerpositioned intermediate the first outer layer 4031 and the second outerlayer 4035.

In various alternative embodiments, an adjunct may not utilize a bondinglayer. For example, an adjunct can utilize the first outer layer 4031and the second outer layer 4035 wherein one or both of the layers 4031,4035 is comprised of a material which is melted to flow and directlybond the layers 4031, 4035 together. Similarly, an adjunct can utilizethe outer layers 4031, 4035 and the middle layer 4033 positionedintermediate the outer layers 4031, 4035 wherein one or more of thelayers 4031, 4033, 4035 is comprised of a material which is melted toflow and directly bond the layers 4031, 4035 to the middle layer 4033.

As discussed above, the layers 4031, 4033, and 4035 of adjunct 4030 arecomprised of interwoven fibers. In certain instances, the layers 4031,4033, and 4035 can have the same, or at least substantially the same,weave density. In other instances, at least one of the layers 4031,4033, and 4035 can have a weave density which is different than theother layers. Referring again to FIG. 77, the adjunct 4030″ comprises afirst outer layer 4031″, a first bonding layer 4032″, a spacer layer4033″, a second bonding layer 4034″, and a second outer layer 4035″. Theweave density of the second outer layer 4035″ is greater than the weavedensity of the first outer layer 4031″ Similarly, the weave density ofthe first outer layer 4031″ is greater than the weave density of thespacer layer 4033″.

As discussed above, the bonding layers 4032 and 4034 of the adjunct4030, when melted, can penetrate the adjacent layers 4031, 4033, and4035. The penetration of the bonding layers 4032 and 4034 into thelayers 4031, 4033, and 4035 can change the stiffness of the layers 4031,4033, and 4035. More specifically, the penetration of the bonding layers4032, 4034 into the layers 4031, 4033, 4035 can increase the stiffnessof the layers 4031, 4033, 4035, depending on the degree in which thebonding layers 4032, 4034 penetrate the layers 4031, 4033, 4035. Invarious instances, the bonding layers 4032, 4034 can strengthen, fixate,and/or support the fibers of the adjacent layers 4031, 4033, 4035.

Further to the above, the weave densities of the layers 4031, 4033,and/or 4035 can be selected so as to control the penetration of thelayers 4032, 4034 therein. Referring now to FIGS. 91 and 92, an adjunct4730 comprises a first outer layer 4731, an intermediate layer 4733, afirst bonding layer 4732 positioned intermediate the first outer layer4731 and the intermediate layer 4733, a second outer layer 4735, and asecond bonding layer 4734 positioned intermediate the second outer layer4735 and the intermediate layer 4733. Certain portions of theintermediate layer 4733 have a low, or loose, weave density while otherportions of the intermediate layer 4733 have a high, or tight, weavedensity. When the adjunct 4730 is heated to a temperature that at leastequals the melt temperature of the first bonding layer 4732, the firstbonding layer 4732 penetrates deeper into the portions of theintermediate layer 4733 having a loose weave density than the portionsof the intermediate layer 4733 having a tight weave density. In additionto or in lieu of the above, the weave densities of the first outsidelayer 4731 and/or the second outside layer 4735 can be adapted tocontrol the penetration of the bonding layers 4732 and 4734 into theoutside layers 4731 and 4735, respectively.

Further to the above, referring again to FIG. 75, the density, size,and/or depth of the apertures 4036 can be selected to control the depthin which the layers 4032 and 4034 penetrate into the spacer layer 4033.As a result of the above, the stiffness of the adjunct 4030 can becontrolled. For instance, the adjunct 4030 can comprise a longitudinalpath defined therein which has a lower stiffness than the other portionsof the adjunct 4030. In such instances, a knife transecting the adjunct4030 can transect the adjunct 4030 along a path having a low stiffness.In at least one instance, the proximal and distal ends of the adjunct4030 can have a lower stiffness than the other portions of the adjunct4030. In such instances, the adjunct 4030 may provide less resistance tothe cutting and stapling thereof at the beginning and the end of thefiring stroke.

In various alternative embodiments, an adjunct can comprise a bondinglayer which does not penetrate, or at least substantially penetrate, theadjacent layers of the adjunct. In such embodiments, the bonding layercan join adjacent layers without substantially affecting the stiffnessof the adjacent layers. Turning now to FIG. 90, an adjunct 4630comprises a bonding layer 4632 which holds a first outer layer 4631 andan intermediate layer 4633 together without penetrating the first outerlayer 4631 and/or the intermediate layer 4633. Similarly, the adjunct4630 comprises a bonding layer 4634 which holds a second outer layer4635 and the intermediate layer 4633 together without penetrating thesecond outer layer 4635 and/or the intermediate layer 4633.

As described above, an adjunct can comprise a bonding layer positionedintermediate first and second outer layers. Turning now to FIGS. 80 and81, an adjunct 4230 comprises a first outer layer 4231, a second outerlayer 4235, and an intermediate layer 4233 positioned intermediate thefirst outer layer 4231 and the second outer layer 4235. In thisembodiment, the outer layers 4231 and 4235 are comprised of one or morematerials having a lower melt temperature than the melt temperature ofthe materials comprising the intermediate layer 4233. As a result, themelt temperatures of the outside layers 4231 and 4235 define thethreshold melt temperature of the adjunct 4230. The adjunct 4230 isexposed to a processing temperature which at least partially melts theoutside layers 4231 and 4235 but does not melt the intermediate layer4233.

In addition to or in lieu of the above, one or more layers of animplantable adjunct can include relief, or stretch, joints. Moreover,one or more layers of an implantable adjunct can include relief, orstretch, slots defined therein. Turning now to FIG. 78, an implantableadjunct 4130 comprises a first outside layer 4131, a second outsidelayer 4135, and a bonding layer 4133 positioned intermediate the firstoutside layer 4131 and the second outside layer 4135. Turning now toFIGS. 79 and 82, the first outside layer 4131 comprises relief joints4137 which extend laterally through the layer 4131. As illustrated inFIG. 83, the lateral relief joints 4137 decrease the longitudinalstiffness of the layer 4131, and the adjunct 4130, and facilitate thelongitudinal expansion of the layer 4131, and the adjunct 4130. Therelief joints 4137 have the same length; however, alternativeembodiments are envisioned in which one or more of the relief joints4137 have lengths which are different than the lengths of the otherrelief joints 4137.

Referring again to FIG. 79, the second outside layer 4135 comprisesrelief joints 4136 which extend longitudinally through the layer 4135.The longitudinal joints 4136 extend between a proximal end and a distalend of the adjunct 4130. The longitudinal relief joints 4136 decreasethe lateral stiffness of the layer 4131, and the adjunct 4130, andfacilitate the lateral expansion of the layer 4131, and the adjunct4130. The relief joints 4136 have the same length; however, alternativeembodiments are envisioned in which one or more relief joints 4136 havelengths which are different than the lengths of the other relief joints4136.

Referring to FIGS. 79 and 84, the bonding layer 4133 comprises an arrayof slits 4138 defined therein. The slits 4138 are arranged inlongitudinal rows which extend along longitudinal axes. Each slit 4138comprises an elongate configuration wherein the longest dimension ofeach slit 4138 is aligned with an axis of a longitudinal row. Asillustrated in FIG. 85, the slits 4138 facilitate the longitudinaland/or lateral expansion of the layer 4133 and the adjunct 4130. Theslits 4138 have the same configuration; however, alternative embodimentsare envisioned in which one or more slits 4138 have configurations whichare different than the configurations of the other slits 4138. Invarious instances, any suitable layer of an adjunct can include theslits 4138.

Turning now to FIG. 86, a layer 4233 of an adjunct comprises apertures4238 defined therein which are configured to facilitate the longitudinaland/or lateral stretch of the layer 4233. Each aperture 4238 comprises adiamond configuration. The apertures 4238 defined in one row are offsetlaterally and longitudinally with respect to the apertures 4238 definedin an adjacent row. Turning now to FIG. 87, a layer 4333 of an adjunctcomprises apertures 4338 defined therein which are configured tofacilitate the longitudinal and/or lateral stretch of the layer 4333.Each aperture 4338 comprises a circular configuration. The apertures4338 defined in one row are aligned with the apertures 4338 defined inan adjacent row. Turning now to FIG. 88, a layer 4433 of an adjunctcomprises apertures 4438 defined therein which are configured tofacilitate the longitudinal and/or lateral stretch of the layer 4433.Each aperture 4438 comprises a zig-zag slit that extends laterally andlongitudinally. The apertures 4438 in one row are offset laterally andlongitudinally with respect to the apertures 4438 in an adjacent row.

The apertures described herein can be created in a layer utilizing anysuitable process. Turning now to FIG. 89A, a layer 4533 of an adjunct4530 comprises a plurality of apertures 4538′ defined therein. Theapertures 4538′ are burned in the layer 4533 utilizing a laser 4539′.Turning now to FIG. 89B, a rotatable die 4539″ is utilized to punchapertures 4538″ into the layer 4533. Turning now to FIG. 89C, a stampingdie 4539′″ is utilized to punch apertures 4538′″ into the layer 4533.

Referring to FIG. 93, a compressible adjunct assembly 6000 includes anouter fibrous tubular member 6002, an inner fibrous tubular member 6010,a first intermediate fibrous tubular member 6004, a second intermediatefibrous tubular member 6006, and a third intermediate fibrous tubularmember 6008. In certain instances, the compressible adjunct assembly6000 may only include the inner and outer fibrous tubular members.Alternatively, the compressible adjunct assembly 6000 may include theinner and outer fibrous tubular members and only one of the intermediatefibrous tubular members. Alternatively, the compressible adjunctassembly 6000 may include the inner and outer fibrous tubular membersand only two of the intermediate fibrous tubular members. Alternatively,the compressible adjunct assembly 6000 may include the inner and outerfibrous tubular members and more than three intermediate fibrous tubularmembers.

In certain instances, the inner fibrous tubular member 6010 can beswitched with a core fibrous construct that is not hollow. In certaininstances, the compressible adjunct assembly 6000 may be comprised of aplurality of hollow fibrous members that are not tubular or cylindricalin shape. In certain instances, the plurality of hollow fibrous membersof the compressible adjunct assembly 6000 may comprise a square-shapedor rectangular transverse cross-sectional area. Other shapes arecontemplated by the present disclosure.

Like other compressible adjunct assemblies of the present disclosure,the compressible adjunct assembly 6000 can be assembled with a jawmember of a surgical stapling and severing instrument such as, forexample, the anvil 8014 and/or the staple cartridge 10000 of thesurgical stapling and severing instrument 8010. In certain instances, afirst compressible adjunct assembly 6000 can be assembled with the anvil8014 and a second compressible adjunct assembly 6000 can be assembledwith the staple cartridge 10000 such that tissue is captured between thefirst and second compressible adjunct assemblies 6000 when the surgicalstapling and severing instrument 8010 is in a closed configuration. Ineither event, a plurality of staples can be deployed into a compressibleadjunct assembly 6000 to fasten tissue captured by the surgical staplingand severing instrument 8010.

The fibrous tubular members of the compressible adjunct assembly 6000are concentrically aligned along a longitudinal axis L-L and disposedaround, or at least partially around, one another, as illustrated inFIG. 93. The second intermediate fibrous tubular member 6006 is disposedbetween the first and third intermediate fibrous tubular members 6004and 6008. For the sake of brevity, the following discussion of thecompressible adjunct assembly 6000 will focus on the second intermediatefibrous tubular member 6006 in addition to the outer and inner fibroustubular members 6002 and 6010. The reader, however, will appreciate thatthe following discussion is equally applicable to the first and thirdintermediate fibrous tubular members 6004 and 6008.

Referring to FIG. 93, the inner fibrous tubular member 6010 is sized tofit, or at least partially fit, within the intermediate fibrous tubularmember 6006 to define a cylindrical space or gap 6012 therebetween.Likewise, the intermediate fibrous tubular member 6006 is sized to fit,or at least partially fit, within the outer fibrous tubular member 6002to define a cylindrical space or gap 6014 therebetween. As illustratedin FIG. 93, the inner fibrous tubular member 6010 extends, or at leastpartially extends, through the intermediate fibrous tubular member 6006which extends, or at least partially extends, through the outer fibroustubular member 6002.

Referring to FIG. 93, the fibrous tubular members of the compressibleadjunct assembly 6000 are woven. In certain instances, one or more ofthe fibrous tubular members of the compressible adjunct assembly 6000can be non-woven constructs. In at least one instance, the inner fibroustubular member 6010 can be comprised of a non-woven fibrous constructthat is not hollow. In any event, the fibers of the adjacent fibroustubular members of the compressible adjunct assembly 6000 areintertwined, interrelated, and/or capable of interaction with oneanother.

One or more of the fibrous tubular members and/or fibrous constructs ofthe compressible adjunct assembly 6000 includes at least one fiber thatis constricted or shrunk in response to a thermal treatment of thecompressible adjunct assembly 6000.

The at least one fiber is comprised of at least one biocompatiblematerial that experiences a reduction in size when heated to thepredetermined temperature. In at least one instance, the at least onebiocompatible material is an elastomer. In certain instances, the atleast one biocompatible material has a glass transition temperaturebelow ambient temperature.

In certain instances, the thermal treatment comprises heating thecompressible adjunct assembly 6000 to a predetermined temperature. Forexample, the compressible adjunct assembly 6000 can be inserted into anoven, which can be heated to the predetermined temperature. Othertechniques for delivering the thermal treatment to the compressibleadjunct assembly 6000 are contemplated by the present disclosure.

Further to the above, one or more of the fibrous tubular members and/orfibrous constructs of the compressible adjunct assembly 6000 includes atleast one fiber that has experienced a transition from a more orderedphase to a less ordered phase in response to the thermal treatment ofthe compressible adjunct assembly 6000. In at least one instance, thecompressible adjunct assembly 6000 includes at least one fiber that hasexperienced an increase in entropy in response to the thermal treatment.

Referring to FIG. 94, the shrinkage or constriction of the at least onefiber reinforces the compressible adjunct assembly 6000 by causing theindividual fibrous tubular members of the compressible adjunct assembly6000 to be brought closer to one another thereby reducing the emptyspace therebetween. The shrinkage of the at least one fiber can densifythe compressible adjunct assembly 6000 by causing the fibers of thefibrous tubular members to bunch up or cluster into more compactsemi-organized or disorganized tubular structures. In result, asillustrated in FIG. 94, the individual fibrous tubular members may losetheir uniform tubular frames and instead adopt irregular shapes withbulges and depressions that improve the structural integrity of thecompressible adjunct assembly 6000.

Referring to FIG. 94, one or more of the fibrous tubular members and/orfibrous constructs of the compressible adjunct assembly 6000 maycomprise

bioabsorbable materials such as, for example, polyglycolic acid (PGA)which is marketed under the trade name VICRYL, polylactic acid (PLA orPLLA), polydioxanone (PDS), polyhydroxyalkanoate (PHA), poliglecaprone25 (PGCL) which is marketed under the trade name MONOCRYL, and/orpolycaprolactone (PCL). One or more of the fibrous tubular membersand/or fibrous constructs of the compressible adjunct assembly 6000 maycomprise one or more composite materials that include two or morepolymers, the polymers selected from a group including PGA, PLA, PDS,PHA, PGCL and/or PCL, for example.

Referring again to FIG. 93, one or more of the fibrous tubular membersand/or fibrous constructs of the compressible adjunct assembly 6000includes a first plurality of fibers comprised of a first biocompatiblematerial such as, for example, VICRYL, and a second plurality of fiberscomprised of a second biocompatible material, different from the firstbiocompatible material, such as, for example PDS. The compressibleadjunct assembly 6000 comprises more of the first biocompatible materialthan the second biocompatible material. In at least one instance, theratio of the first biocompatible material of the first plurality offibers to the second biocompatible material of the second plurality offibers can be any value selected from a range of about 3:1 to about10:1, for example. In at least one instance, the ratio of the firstbiocompatible material to the second biocompatible material can be anyvalue selected from a range of about 4:1 to about 9:1, for example. Inat least one instance, the ratio of the first biocompatible material tothe second biocompatible material can be any value selected from a rangeof about 5:1 to about 8:1, for example. In at least one instance, theratio of the first biocompatible material to the second biocompatiblematerial is 7:1. In at least one instance, the ratio of the firstbiocompatible material to the second biocompatible material is about5:1, for example. Other ratios of the first biocompatible material tothe second biocompatible material are contemplated by the presentdisclosure.

In at least one instance, all the fibrous tubular members and/or fibrousconstructs of the compressible adjunct assembly 6000 may comprise thesame, or at least substantially the same, ratio of the firstbiocompatible material to the second biocompatible material.Alternatively, the fibrous tubular members and/or fibrous constructs ofthe compressible adjunct assembly 6000 may comprise different ratios ofthe first biocompatible material to the second biocompatible material.

The compressible adjunct assembly 6000 is heated to a predeterminedtemperature at which the second plurality of fibers experiences areduction in size corresponding to an increase in Entropy in response tothe thermal treatment. In certain instances, the first plurality offibers and the second plurality of fibers are entangled such that theshrinkage of the second plurality of fibers causes some or all of thefirst plurality of fibers to be pulled together, which densities thecompressible adjunct assembly 6000. In certain instances, the secondplurality of fibers are in an outer fibrous tubular member of thecompressible adjunct assembly 6000 while the first plurality of fibersare in an inner fibrous tubular member of the compressible adjunctassembly 6000. In such instances, the second plurality of fibers, whileshrinking, may cause the outer fibrous tubular member to constrict theinner fibrous tubular member.

Referring now to FIGS. 95-97, a compressible adjunct assembly 6100 issimilar in many respects to the compressible adjunct assembly 6000. Forexample, the compressible adjunct assembly 6100 comprises a plurality offibrous tubular members 6102-6110 that are aligned concentrically anddisposed around, or at least partially around, one another. Also, thecompressible adjunct assembly 6100 can be assembled with a jaw member ofa surgical stapling and severing instrument such as, for example, theanvil 8014 and/or the staple cartridge 10000 of the surgical staplingand severing instrument 8010. As discussed in greater detail below, thecompressible adjunct assembly 6100 is modified into a desired shape by athermal pressing process to be used with the surgical stapling andsevering instrument 8010, for example.

As illustrated in FIG. 95, the compressible adjunct assembly 6100 isinserted into a mold 6020, which can be heated to a predeterminedtemperature. A predetermined external pressure is applied to thecompressible adjunct assembly 6100 to modify the shape of thecompressible adjunct assembly 6100 to the desired shape, as illustratedin FIG. 96. The compressible adjunct assembly 6100 is maintained underthe predetermined conditions of temperature and pressure for apredetermined time period after which the compressible adjunct assembly6100 is allowed to cool or is actively cooled below the predeterminedtemperature while the external pressure is maintained. Finally, theexternal pressure is removed, as illustrated in FIG. 96. Additionaldetails of a thermal pressing process are described in U.S. patentapplication Ser. No. 14/187,383, entitled IMPLANTABLE LAYERS AND METHODSFOR ALTERING IMPLANTABLE LAYERS FOR USE WITH SURGICAL FASTENINGINSTRUMENTS, and filed Feb. 24, 2014, now U.S. Patent ApplicationPublication No. 2015/0238185, the entire disclosure of which isincorporated herein by reference.

Referring again to FIGS. 95-97, one or more of the fibrous tubularmembers 6102-6110 of the compressible adjunct assembly 6100 has aplurality of fibers that comprises a biocompatible material with a glasstransition temperature “Tg”. The predetermined temperature of theprocess described above is set to be greater than or equal to the glasstransition temperature “Tg” but lower than the melting temperature ofthe biocompatible material. As illustrated in FIG. 96, a modifyingmember 6122 is employed to apply the predetermined external pressure tothe compressible adjunct assembly 6100. The predetermined externalpressure is set to a pressure sufficient to modify the compressibleadjunct assembly 6100 to the desired shape. The value of thepredetermined external pressure depends in part on the size of the mold6120, the original size and/or shape of the compressible adjunctassembly 6100, and/or the desired size and/or shape of the compressibleadjunct assembly 6100, for example.

In at least one instance, the predetermined pressure is maintained forapproximately 10 minutes at the predetermined temperature and/or forapproximately 10 minutes at a temperature below the predeterminedtemperature, for example. In certain instances, the predeterminedpressure can be maintained for a period of time from about 30 seconds toabout 8 hours, for example, at the predetermined temperature and/or fora period of time from about 30 seconds to about 8 hours, for example, ata temperature below the predetermined temperature. Other time periodsfor maintaining the predetermined temperature and/or pressure arecontemplated by the present disclosure.

In certain instances, only the outer fibrous tubular member 6102includes a biocompatible material comprising a glass transitiontemperature “Tg” below the predetermined temperature. Nonetheless, themodification to the outer fibrous tubular member 6102 by the thermalpressing process can be sufficient to cause the outer fibrous tubularmember 6102 to hold the remaining fibrous tubular members 6104-6110,disposed within the outer fibrous tubular member 6102, in the desiredshape.

In certain instances, the desired shape of the compressible adjunctassembly 6100 may comprise square-shaped or a rectangular transversecross-sectional area. Other shapes are contemplated by the presentdisclosure. In at least one instance, the compressible adjunct assembly6100 comprises a transverse cross-sectional area in the shape of arectangular prism with edges and ends tapered flat or smashed flat forattachment to and/or alignment with an anvil such as, for example, theanvil 8014, and/or a staple cartridge such as, for example, the staplecartridge 10000.

Referring now to FIGS. 98-100, a compressible adjunct assembly 6200 issimilar in many respects to the compressible adjunct assemblies 6000 and6100. For example, the compressible adjunct assembly 6200 comprises aplurality of fibrous tubular members that are aligned concentrically anddisposed around, or at least partially around, one another. Also, thecompressible adjunct assembly 6200 is shrunk or constricted into acompact semi-organized or disorganized structure causing the individualfibrous tubular members to lose their uniform tubular frames and insteadadopt irregular shapes with bulges 6214 and depressions 6216, asillustrated in FIG. 100, that improve the structural integrity of thecompressible adjunct assembly 6200. Also, like the compressible adjunctassembly 6100, the compressible adjunct assembly 6200 has beentransformed from an initial generally tubular shape to a desired shape,as illustrated in FIG. 99, during a thermal pressing process. Theassembly 6200 is suitable for assembly with a jaw member of a surgicalstapling and severing instrument such as, for example, the anvil 8014and/or the staple cartridge 10000 of the surgical stapling and severinginstrument 8010.

Referring to FIG. 98, the compressible adjunct assembly 6200 isassembled with a staple cartridge 6202 by inserting an attachmentportion 6204 of the compressible adjunct assembly 6200 into an elongateslot 6206 of the staple cartridge 6202. The attachment portion 6204 isslightly larger than the elongate slot 6206. Accordingly, the attachmentportion 6204 is deformed as it is inserted into the elongate slot 6206and the friction built between the deformed attachment portion 6204 andthe walls of the elongate slot 6206 holds the compressible adjunctassembly 6200 against and/or adjacent to a cartridge deck 6208 of thestaple cartridge 6202. The attachment portion 6204 includes alaterally-extended apex portion 6210, as illustrated in FIG. 99, whichimproves the attachment of the compressible adjunct assembly 6200 to thestaple cartridge 6202. In certain instances, additional or alternativeattachment techniques can be employed to releasably attach thecompressible adjunct assembly 6200 to the staple cartridge 6202. In atleast one instance, a biocompatible glue can replace the attachmentportion 6204 or can be used in addition to the attachment portion 6204.In the latter instance, the biocompatible glue can be applied to theattachment portion 6204 prior to its insertion into the elongate slot6206, for example.

Further to the above, the compressible adjunct assembly 6200 includes afirst compressible portion 6232 and a second compressible portion 6234.An elongate slot or a channel 6230 is defined between the firstcompressible portion 6232 and the second compressible portion 6234. Theelongate slot 6230 extends, or at least partially extends, along alength of the elongate slot 6206 of the staple cartridge 6202 when thecompressible adjunct assembly is assembled with the staple cartridge6202. The attachment portion 6204 protrudes from a base 6236 defined atthe bottom of the elongate slot 6230, as illustrated in FIG. 99. As thefiring assembly 9090 (FIG. 3) is advanced to deploy the staples into thecompressible adjunct assembly 6200 and the tissue captured by thesurgical stapling and severing instrument 8010, the cutting edge 9116(FIG. 3) is driven through the elongate slot 6230. In addition, thecutting edge 9116 may cut through the attachment portion 6204.

In certain instances, the attachment portion 6204 is torn from the base6236 to release the compressible adjunct assembly 6200 from the staplecartridge 6202. Alternatively, the attachment portion 6204 is pulled outof the elongate slot 6206 of the staple cartridge 6202 as thecompressible adjunct assembly 6200 is released from the staple cartridge6202. In certain instances, the base 6236 remains intact, or at leastpartially intact, after the compressible adjunct assembly 6200 isreleased from the staple cartridge 6202. In such instances, the base6236 continues to connect the first compressible portion 6232 and secondcompressible portion 6234 after the release is completed. Alternatively,the base 6236 can be severed or torn, which causes the firstcompressible portion 6232 and second compressible portion 6234 to beseparated from one another.

The attachment portion 6204 continuously extends along a length of theelongate slot 6230. In certain instances, the attachment portion 6204 isdivided into a plurality of attachment members that are spaced apartfrom one another and arranged longitudinally along a length of theelongate slot 6230. In at least one instance, the plurality ofattachment members are equidistant from one another. Alternatively, theplurality of attachment members can be arranged closer to each other ina first portion of the elongate slot 6230 than a second portion of theelongate slot 6230. In certain instances, the attachment members can beconcentrated at a proximal portion, a distal portion, and/or a centralportion of the elongate slot 6230, for example.

In at least one instance, one or more of the plurality of attachmentmembers may comprise a top surface with a rectangular, or an at leastsubstantially rectangular, shape. Other shapes are contemplated by thepresent disclosure such as, for example, a circular shape or a domeshape. Like the attachment portion 6204, one or more of the attachmentmembers may include a laterally extending end.

Referring to FIG. 101, one or more of the fibrous tubular members and/orfibrous constructs of the compressible adjunct assembly 6000 includes afirst plurality of fibers 6050 comprised of a first biocompatiblematerial, such as VICRYL, for example, and a second plurality of fibers6052 comprised of a second biocompatible material that is different fromthe first biocompatible material, such as PDS, for example. Asillustrated in FIG. 101, the plurality of second fibers 6052 can bemelted and resolidified to bond and reinforce the plurality of firstfibers 6050.

In certain instances, the compressible adjunct assembly 6000 can beheated to a predetermined temperature that is equal to or greater thanthe melting temperature of the second biocompatible material but lessthan the melting temperature of the first biocompatible material. Insuch instances, the plurality of second fibers 6052 are melted. Themelted material flow along, onto, and/or between the plurality of firstfibers 6050. Upon cooling, the melted fibers 6052 bond to the fibers6050 and interconnect adjacent fibers thereby reinforcing the structureof the compressible adjunct assembly 6000, as illustrated in FIG. 101.

Referring to FIG. 102, a compressible adjunct assembly 6200 includesbiocompatible fibers 6302 that are entangled to form a three-dimensionalstructure. In addition, the compressible adjunct assembly 6200 includesa bonding medium 6310 that defines nexus points or bonding nodes 6304that reinforce the three-dimensional structure of the compressibleadjunct assembly 6200. The bonding nodes 6304 include adjacent portionsof the fibers 6302 that are surrounded, or at least partiallysurrounded, by the bonding medium 6310 which affixes such adjacentportions of the fibers 6302.

Referring again to FIG. 102, a first fiber 6302′ extends over a secondfiber 6302″, while the bonding medium 6310 extends between adjacentportions of the fibers 6302′ and 6302″. The bonding medium 6310 isattached to the adjacent portions of the fibers 6302′ and 6302″ defininga bonding node 6304′. Other arrangements of the fibers 6302 and thebonding nodes 6304 are contemplated by the present disclosure. In atleast one instance, the bonding medium 6310 may join an end portion ofone fiber with an intermediate portion of another fiber to define abonding node, for example.

The bonding nodes 6304 define load bearing zones within the compressibleadjunct assembly 6200, which are characterized by an increased densityand/or a greater stiffness compared to surrounding zones which lack thebonding nodes 6304. The load bearing zones can be employed as attachmentregions for securing the compressible adjunct assembly 6200 to a jawmember of a surgical stapling and severing instrument such as, forexample, the anvil 8014 and/or the staple cartridge 10000 of thesurgical stapling and severing instrument 8010.

In certain instances, a first compressible adjunct assembly 6200 can beassembled with the anvil 8014 and a second compressible adjunct assembly6200 can be assembled with the staple cartridge 10000 such that tissueis captured between the first and second compressible adjunct assemblies6300 when the surgical stapling and severing instrument 8010 is in aclosed configuration. Also, a plurality of staples can be deployed intothe compressible adjunct assembly 6200 to fasten tissue captured by thesurgical stapling and severing instrument 8010, as described in greaterdetail elsewhere in the present disclosure.

Referring again to FIG. 10A, the compressible adjunct assembly 6200 isfabricated from a plurality of the fibers 6302 and a plurality ofbonding fibers that are reshaped or altered to form the bonding medium6310. The fibers 6302 and the bonding fibers are entangled into athree-dimensional structure that ultimately forms the compressibleadjunct assembly 6200. The fibers 6302 are fabricated, or at leastpartially fabricated, from a first biocompatible material with a firstmelting point, while the bonding fibers are fabricated, or at leastpartially fabricated, from a second biocompatible material with a secondmelting point that is less than the first melting point of the firstbiocompatible material. Furthermore, the fibers 6302 lack or exclude thesecond biocompatible material of the bonding fibers; however, smallamounts of the second biocompatible material can be present in the fiber6302 in certain embodiments.

In certain instances, the fibers 6302 can be fabricated from a pluralityof biocompatible materials with melting points that are greater than themelting point(s) of the biocompatible material(s) of the bonding fibers.Similarly, the bonding fibers can be fabricated from a plurality ofbiocompatible material with melting points that are less than themelting point(s) of the biocompatible material(s) of the fibers 6302.

Further to the above, the three-dimensional structure of the entangledfibers 6302 and bonding fibers can be subjected to one or more thermalpressing treatments. Predetermined pressures and/or temperatures areapplied to a three-dimensional structure of the entangled fibers 6302and bonding fibers resulting in the formation of the compressibleadjunct assembly 6200. In certain instances, the pressure can be removedand the three-dimensional structure is only subjected to thepredetermined temperature. In other instances, the pressure can besubstituted with tension that may stretch the three-dimensionalstructure. In certain instances, various combinations of pressure andtension can be employed to mold the three-dimensional structure into adesired shape.

Referring to FIG. 103, the mold 6120 and the modifying member 6122 areemployed to implement the thermal pressing treatment. Thethree-dimensional structure, which ultimately becomes, the compressibleadjunct assembly 6200, is inserted into the mold 6120. The modifyingmember 6122 is then operated to apply a predetermined pressure to thethree-dimensional structure to bring the three-dimensional structure toa desired shape. The applied pressure brings adjacent portions of thefibers 6302 and the bonding fibers into a closer proximity inpreparation for the transition of the bonding fibers into the bondingmedium 6310.

While the predetermined pressure is maintained, the mold is heated tobring the three-dimensional structure to the predetermined temperature.The predetermined temperature is a temperature, or range oftemperatures, capable of melting the bonding fibers but not the fibers6302. Said another way, the predetermined temperature is anytemperature, or range of temperatures, greater than or equal to themelting point of the second biocompatible material but less than themelting point of the first biocompatible material. The melted bondingfibers flow along, onto, and/or between the fibers 6302.

As the system is actively cooled or allowed to cool to a temperaturelower than the predetermined temperature, the bonding medium 6310 isresolidified causing the formation of the bonding nodes 6304 betweenadjacent portions of the fibers 6302. Furthermore, the bonding medium6310 may coat, or at least partially coat, at least portions of thefibers 6302 along their lengths, as illustrated in FIG. 104. Thepredetermined pressure can be maintained during cooling. Thepredetermined pressure can also be maintained for a predetermined periodof time after the cooling is completed. When the pressure is removed,the newly formed bonding nodes 6304 maintain, or at least partiallymaintain, the new shape of the compressible adjunct assembly 6200.

In certain instances, the predetermined pressure causes thethree-dimensional structure to decrease in height. In at least oneinstance, the reduction in height is selected from a range of values ofabout 1% to about 200%, for example. Other values for the reduction inheight that is caused by the application of the predetermined pressureare contemplated by the present disclosure. Similar reductions in lengthand/or width are also contemplated by the present disclosure. Ininstances where tension is applied, one or more of the dimensions ofthree-dimensional structure may experience an increase in value. In anyevent, as illustrated in FIG. 103, the resulting compressible adjunctassembly 6200 comprises a shape suitable for assembly with a jaw memberof a surgical stapling and severing instrument such as, for example, theanvil 8014 and/or the staple cartridge 10000 of the surgical staplingand severing instrument 8010.

In at least one instance, the predetermined pressure is maintained forapproximately 10 minutes before heating, approximately 10 minutes at thepredetermined temperature, and/or approximately 10 minutes at atemperature below the predetermined temperature, for example. In certaininstances, the predetermined pressure can be maintained for a period oftime from about 30 seconds to about 8 hours, for example, beforeheating, for a period of time from about 30 seconds to about 8 hours,for example, at the predetermined temperature, and/or for a period oftime from about 30 seconds to about 8 hours, for example, at atemperature below the predetermined temperature. Other time periods formaintaining the predetermined temperature and/or pressure arecontemplated by the present disclosure.

As illustrated in FIG. 102, the fibers 6302 of the compressible adjunctassembly 6200 are disorganized and randomly entangled. Accordingly, thebonding nodes 6304 of the compressible adjunct assembly 6200 are alsodisorganized and randomly positioned within the compressible adjunctassembly 6200. Alternatively, it may be desirable to producecompressible adjunct assemblies with bonding nodes that are organizedinto a planned framework. To do so, the fibers of the three-dimensionalstructure are systematically organized in a planned pattern. In at leastone instance, the fibers are knitted or woven into a matrix or networkwith intersection points that are designed to give rise to bondingnodes.

Referring to FIG. 104, a compressible adjunct assembly 6400 is similarin many respects to the compressible adjunct assembly 6200. For example,the compressible adjunct assembly 6400 can be releasably attached to ajaw member of a surgical stapling and severing instrument such as, forexample, the anvil 8014 and/or the staple cartridge 10000 of thesurgical stapling and severing instrument 8010. In addition, thecompressible adjunct assembly 6400 includes first fibers 6402 spacedapart from one another and generally arranged in a first direction, andsecond fibers 6403 which are also spaced apart from one another andgenerally arranged in a second direction intersecting the firstdirection. The first fibers 6402 and the second fibers 6403 areintertwined forming a matrix or network of fibers with a plurality ofintersection points.

The compressible adjunct assembly 6400 also includes bonding fibers thatare melted and resolidified to form a bonding medium 6410 that definesbonding nodes 6404 at the intersection points between the first fibers6402 and the second fibers 6403. A bonding node 6404 may includeportions of one or more fibers 6402 and portions of one or more fibers6403. The bonding fibers can be strategically arranged adjacent to thefibers 6402 and/or 6403 to allow the bonding medium 6410 to flow along,onto, and/or between the fibers 6402 and/or 6403.

Referring again to FIG. 104, the framework defined by the first fibers6402 and the second fibers 6403 is embedded, or at least partiallyembedded, in the bonding medium 6410. In certain instances, a bondingnode 6404 is formed at an intersection point between a fiber 6402 and afiber 6403. In certain instances, a bonding node 6404 is formed at anintersection point between three fibers including one fiber 6402 and twofibers 6403, or two fibers 6402 and one fiber 6403. Other bonding nodes6404 may comprise various other combinations of the fibers 6402 and6403.

The distance between adjacent fibers of the compressible adjunctassembly 6400 can determine, at least in part, the extent to which suchspace is filled or bridged by the bonding medium 6410. The greater thedistance between adjacent fibers the less likely it is for the meltedbonding fibers to bridge the gap between such adjacent fibers. Thefluidity of the melted bonding fibers and/or the thickness of thebonding fibers can also determine whether the bonding medium 6410 iscapable of filling or bridging a space therebetween. Spaces that remainunfilled define gaps 6408 that can be in different shapes and sizes, asillustrated in FIG. 104. The number and size of the gaps 6408 determine,among other things, the porosity of the compressible adjunct assembly6400. Accordingly, the porosity of the compressible adjunct assembly6400 can be increased by increasing the distances between the adjacentfibers. Alternatively, the porosity of the compressible adjunct assembly6400 can be decreased by decreasing the distances between the adjacentfibers. In at least one instance, a gap 6408 is defined by a pluralityof fibers including two of the fibers 6402 and two of the fibers 6403that intersect to form four bonding nodes 6404 around the gap 6408.

Referring now to FIG. 105, a compressible adjunct assembly 6500 issimilar in many respects to the compressible adjunct assemblies 6300 and6400. For example, the compressible adjunct assembly 6400 can bereleasably attached to a jaw member of a surgical stapling and severinginstrument such as, for example, the anvil 8014 and/or the staplecartridge 10000 of the surgical stapling and severing instrument 8010.

In addition, the compressible adjunct assembly 6500 includes a topportion 6512 and a bottom portion 6514 which is spaced apart from thetop portion 6512. A plurality of fibers 6502 and a plurality of fibers6503 extend between the top portion 6512 and the bottom portion 6514.The fibers 6502 are spaced apart and extend in parallel, or at leastsubstantially in parallel, to one another in a first direction definedby an axis A-A. Likewise, the fibers 6503 are spaced apart and extend inparallel, or at least substantially in parallel, to one another in asecond direction defined by an axis B-B. The top portion 6512 and thebottom portion 6514 are parallel, or at least substantially parallel, toone another. The axis A-A intersects the top portion 6512 and the bottomportion 6514 at an angle α1 while the axis B-B intersects the topportion 6512 and the bottom portion 6514 at an angle α2. The angle α2 isgreater than the angle α1.

In certain instances, the angle α2 is greater than 90° and the angle α1is less than 90°, for example. In at least one instance, the angle α1 isselected from a range of about 45° to about 85°, for example. In atleast one instance, the angle α2 is selected from a range of about 135°to about 175°, for example. In at least one instance, the angle α1 isabout 60°, for example. In at least one instances, the angle α2 is about150°, for example. Other values for the angles α1 and α2 arecontemplated by the present disclosure.

Further to the above, each fiber 6502 includes an intermediate portion6502 b extending between two end portions 6502 a and 6502 c. Likewise,each fiber 6503 includes an intermediate portion 6503 b extendingbetween two end portions 6503 a and 6503 c. The intermediate portions6502 b and 6503 b intersect forming an angle α3 therebetween, asillustrated in FIG. 105. The angle α3 is less than 90°. In certaininstances, the angle α3 is selected from a range of about 15° to about85°, for example. In at least one instance, the angle α3 is about 35°,for example. Other values for the angle α3 are contemplated by thepresent disclosure.

Referring again to FIG. 105, an end portion 6502 a of a fiber 6502intersects an end portion 6503 a of an adjacent fiber 6503 and definesan angle α4 therebetween. The end portions 6502 a and 6503 a areanchored to the top portion 6512 at their points of intersection.Likewise, an end portion 6502 c intersects an end portion 6503 cdefining an angle α5 therebetween. The end portions 6502 c and 6503 care anchored to the bottom portion 6514 at their points of intersection.In certain instances, the angles α4 and α5 are the same, or at leastsubstantially the same. In at least one instance, the angles α4 and α5are selected from a range of about 15 to about 85, for example.

Further to the above, the compressible adjunct assembly 6500 includes abonding medium 6510 that defines nexus points or bonding nodes thatreinforce the three-dimensional structure of the compressible adjunctassembly 6500. Bonding nodes 6504 a include intersecting the endportions 6502 a and 6503 a that are surrounded, or at least partiallysurrounded, by the bonding medium 6510 which affixes the intersectingend portions 6502 a and 6503 a. Likewise, bonding nodes 6504 c includeintersecting the end portions 6502 c and 6503 c that are surrounded, orat least partially surrounded, by the bonding medium 6510 which affixesthe intersecting end portions 6502 c and 6503 c. The compressibleadjunct assembly 6500 includes bonding nodes 6504 b that includeintersecting the intermediate portions 6502 b and 6503 b that aresurrounded, or at least partially surrounded, by the bonding medium 6510which affixes the intersecting intermediate portions 6502 b and 6503 b.Like the compressible adjunct assembly 6200, the compressible adjunctassembly 6500 also includes bonding fibers that are melted andresolidified to form the bonding medium 6510 in the same, or at leastsubstantially the same, manner the bonding medium 6310 is formed.

Referring again to FIG. 105, the bonding nodes 6504 a are aligned in atop row 6516, the bonding nodes 6504 c are aligned in a bottom row 6518,and the bonding nodes 6504 b are aligned in an intermediate row 6520between the top row 6516 and the bottom row 6518. The intermediate row6520 of the bonding nodes 6504 b is out of alignment with the top row6516 of the bonding nodes 6504 a and the bottom row 6518 of the bondingnodes 6504 c. Said another way, a bonding node 6504 b is aligned with afirst gap between two consecutive bonding nodes 6504 a, and a second gapbetween two consecutive bonding nodes 6504 c. This arrangement improvesthe stability of the compressible adjunct assembly 6500. Theintermediate row 6520 is equidistant, or at least substantiallyequidistant, from the rows 6516 and 6518. In certain instances, theintermediate row 6520 is closer to the top row 6516 than the bottom row6518. Alternatively, in other instances, the intermediate row 6520 canbe closer to the bottom row 6518 than the top row 6516. The reader willappreciate that the terms top and bottom as used herein are forconvenience purposes only. The compressible adjunct assembly 6500 can beturned up side down such that the bottom row 6516 is on the top and thetop row 6518 is on the bottom.

Referring again to FIG. 105, the bonding medium 6510 at the bondingnodes 6504 b prevents, or at least resists, translation of thetransecting fibers 6502 and 6503 relative to one another. Thisarrangement can, at least in part, increase the column strength of thecompressible adjunct assembly 6500 and/or improve its spring rate.Although the compressible adjunct assembly 6500 is depicted to only havethree rows of bonding nodes. It is understood that this number of rowsis provided as an example. In certain instances, the compressibleadjunct assembly 6500 may include only two rows of bonding nodes.Alternatively, the compressible adjunct assembly 6500 may include fouror more rows of bonding nodes.

In certain instances, a first building block of the compressible adjunctassembly 6500 includes five bonding nodes, wherein a central bondingnode 6504 b is suspended between two first bonding nodes 6504 a and twofirst bonding nodes 6504 c. The central bonding node 6504 b is tetheredto each of the four bonding nodes 6502 a and 6502 c by a portion ofeither a fiber 6502 or a fiber 6503. Tethering portions 6522 are notcovered by the bonding medium 6510. A second building block of thecompressible adjunct assembly 6500 may be positioned on a first side ofthe first building block. The second building block may also becomprised of five bonding nodes, and may share bonding nodes with thefirst building block. Moreover, a third building block of thecompressible adjunct assembly 6500 may be positioned on a second side ofthe first building block opposite the first side, for example, such thatthe first building block is positioned between the second building blockand the third building block. The third building block may also becomprised of five bonding nodes, and may share bonding nodes with thefirst building block.

Referring again to FIG. 105, as described above, the tethering portions6522 of the fibers 6502 and 6503 are not covered by the bonding medium6510. Alternatively, one or more of the tethering portions 6522 can becovered, or at least partially covered, by the bonding medium 6510 toincrease the stiffness of the building blocks of the compressibleadjunct assembly 6500, which increases the overall stiffness of thecompressible adjunct assembly 6500. It is envisioned that the stiffnessof the compressible adjunct assembly 6500 can be controlled by varyingthe stiffness of the tethering portions 6522 to selectively produce amore or less compressible adjunct 6522.

Referring now to FIG. 106, a compressible adjunct assembly 6600 issimilar in many respects to the compressible adjunct assemblies 6300,6400, and 6500. For example, the compressible adjunct assembly 6600 canbe releasably attached to a jaw member of a surgical stapling andsevering instrument such as, for example, the anvil 8014 and/or thestaple cartridge 10000 of the surgical stapling and severing instrument8010. Also, the compressible adjunct assembly 6600 includes the topportion 6512 and the bottom portion 6514.

Further to the above, the compressible adjunct assembly 6600 includes aplurality of building blocks 6630. As illustrated in FIG. 106, abuilding block 6630 includes a first fiber 6602, a second fiber 6603,and a bonding fiber. The bonding fiber is melted and resolidified toform a bonding medium 6610 in the same, or at least substantially thesame, manner that the bonding mediums 6310, 6410, and 6510 are formed.The fibers 6602 and 6603 in a building block 6630 extend in parallel, orat least substantially in parallel, with one another between the topportion 6512 and the bottom portion 6514. An inner transverse distance“A” separates the fibers 6602 and 6603. The bonding fiber extends, or atleast partially extends, between the top portion 6512 and the bottomportion 6514 along a transverse axis Z-Z defined in the space betweenthe fibers 6602 and 6603.

Referring again to FIG. 106, the bonding medium 6610 defines nexuspoints or bonding nodes 6604 that reinforce the three-dimensionalstructure of the compressible adjunct assembly 6600. The bonding nodes6604 include adjacent portions of the fibers 6302 and 6603 that aresurrounded, or at least partially surrounded, by the bonding medium 6110which affixes such adjacent portions of the fibers 6302 and 6603. Thefibers 6602 and 6603 are completely embedded in the bonding medium 6610.Alternatively, in certain instances, the fibers 6602 and 6603 are onlypartially embedded in, or covered by, the bonding medium 6610.

The inner transverse distance “A” within a building block 6630 of thecompressible adjunct assembly 6600 can determine, at least in part, theextent to which such space is filled or bridged by the bonding medium6610. The fluidity of the melted bonding fibers and/or the thickness ofthe bonding fibers can also determine whether the bonding medium 6610 iscapable of filling or bridging the inner transverse distance “A”. Spacesthat remain unfilled define gaps 6608 that can be in different shapesand sizes, as illustrated in FIG. 106. The number and size of the gaps6608 determine, among other things, the porosity of the compressibleadjunct assembly 6600. Accordingly, the porosity of the compressibleadjunct assembly 6600 within a building block 6630 can be increased byincreasing the inner transverse distance “A”. Alternatively, theporosity of the compressible adjunct assembly 6600 within a buildingblock 6630 can be decreased by decreasing the inner transverse distance“A”.

Referring again to FIG. 106, adjacent building blocks 6630 are spacedapart with sufficient space therebetween to prevent flow of the meltedbonding fibers between the adjacent building blocks 6630. Anintermediate distance “B” is defined between adjacent building blocks6630. The intermediate distance “B” is greater than the inner transversedistance “A”. The intermediate distance “B” is also greater than anouter transverse distance “C” defined by the building blocks 6630. In atleast one instance, the ratio of the outer transverse distance “C” tothe intermediate distance “B” is any ratio selected from a range ofabout 0.1, for example, to about 0.9, for example. In at least oneinstance, the ratio of the outer transverse distance “C” to theintermediate distance “B” is any ratio selected from a range of about0.2, for example, to about 0.8, for example. In at least one instance,the ratio of the outer transverse distance “C” to the intermediatedistance “B” is any ratio selected from a range of about 0.3, forexample, to about 0.7, for example. In at least one instance, the ratioof the outer transverse distance “C” to the intermediate distance “B” isabout 0.4, for example. Other values for the ratio of the outertransverse distance “C” to the intermediate distance “B” arecontemplated by the present disclosure.

Referring now to FIG. 107, a compressible adjunct assembly 6700 issimilar in many respects to the compressible adjunct assemblies 6300,6400, 6500, and 6600. For example, the compressible adjunct assembly6700 can be releasably attached to a jaw member of a surgical staplingand severing instrument such as, for example, the anvil 8014 and/or thestaple cartridge 10000 of the surgical stapling and severing instrument8010. Also, the compressible adjunct assembly 6700 includes the topportion 6512, the bottom portion 6514, and a plurality of buildingblocks 6730 that include the first fiber 6602 and the second fiber 6603.In addition, the building blocks 6730 include angled bonding fibers thatare melted and resolidified to form a bonding medium 6710 in the same,or at least substantially the same, manner that the bonding mediums6310, 6410, 6510 and 6610 are formed.

Referring now to FIG. 107, the bonding medium 6710 within a buildingblock 6730 extends, or at least partially extends, along an axis z-zthat transects the top portion 6512 and the bottom portion 6514 at anangle α1. The angle α1 is less than 90°. In certain instances, the angleα1 is in a range of about 15° to about 85°. In at least one instance,the angle α1 is about 45°. Other values for the angle α1 arecontemplated by the present disclosure.

The bonding medium 6710 within a building block 6730 includes a firstbonding portion 6710 a extending between the top portion 6512 and afirst fiber 6602 on a first side of the fiber 6602. A second bondingportion 6710 b extends between a second side of the first fiber 6602 anda first side of a fiber 6603 extending in parallel, or at leastsubstantially in parallel, with the first fiber 6602. In addition, athird bonding portion 6710 c extends between a second side of the secondfiber 6603 and the bottom portion 6214. The first bonding portion 6710 aaffixes the first fiber 6602 to the top portion 6512 and the thirdbonding portion 6710 c affixes the second fiber 6603 to the bottomportion 6514. In addition, the second bonding portion 6710 b affixes thefirst fiber 6602 to the second fiber 6603. Such an arrangementstabilizes the building block 6730 by providing additional anchors forthe fibers 6602 and 6603 in the form of the bonding portions 6710 a and6710 c, respectively, and by affixing the first fiber 6602 to the secondfiber 6603 via the second bonding portion 6710 b, as illustrated in FIG.107.

Further to the above, the fiber portion 6710 a, 5710 b, and 6710 cextend along an axis z-z at an intersection angles α2 and α3. In atleast one instance, the intersection angles α2 and α3 are the same. Inat least one instance, the intersection angles α2 and α3 are different.In at least one instance, one or both of the intersection angles α2 andα3 are in a range of about 105° to about 175°, for example. In at leastone instance, one or both of the intersection angles α2 and α3 are in arange of about 125° to about 165°, for example. Other values for theintersection angles α2 and α3 are contemplated by the presentdisclosure.

Further to the above, an implantable layer, or adjunct, can bemanufactured and/or modified utilizing any suitable process to providethe layer with desirable properties. In various instances, animplantable adjunct can be manufactured utilizing fused filamentfabrication, for example. In at least one such instance, a polymericfilament, for example, is fed into an extruder, heated, and then forcedthrough a nozzle into a mold and/or directly onto a staple cartridge.The filament is fed into an extruder by a pinch system which can controlthe direction and/or rate in which the filament is fed into theextruder. The filament is at least partially melted by a heater block.The heater block can be positioned upstream with respect to the nozzleand/or within the nozzle. The mold and/or staple cartridge is positionedon a movable bed which can be moved relative to the nozzle. Such a fusedfilament fabrication process can be used to control the porosity withinthe implantable adjunct. In at least one instance, the heated polymericfilament is dispensed in interconnected patterns utilizing triangles,arcs, hexagonal shapes, and/or any suitable polygonal shapes, forexample. Moreover, the heated polymeric material can be dispensed in onelayer or a plurality of layers stacked on one another. The pattern(s)and the number of layers in which the polymeric material is dispensedcan control the porosity of the implantable adjunct. A more porousimplantable adjunct can promote tissue in-growth into the implantableadjunct. In addition, such a process can create an implantable adjunctwithout using a lyophilization process and/or dioxane, for example.

Further to the above, a laser process can be utilized to create openingsin an implantable adjunct. In at least one instance, a laser can beutilized to cut holes into an extruded film comprised of PGA and/or PCL,for example. The film can comprise a thickness of approximately 0.003″,for example, and the holes can comprise a diameter of approximately0.001″, for example. The holes can be microvoids, for example, and cancomprise any suitably-shaped perimeter, such as round, hexagonal, and/ortriangular, for example. Any suitable number of holes can be created.For example, hundreds of holes could be utilized in an implantableadjunct. The holes can be uniformly distributed, or distributed in anysuitable manner. In various instances, the holes can be distributed in apattern including rows which are aligned laterally, longitudinally,and/or diagonally, for example. In various instances, several layers ofextruded film can be stacked and bonded to one another to form theimplantable adjunct. For instance, four or five film layers could beused, for example. Also, for instance, the film layers can be bonded byheating the film layers above the glass transition temperature of atleast one of the film layers without utilizing an adhesive. The layersof film can have the same pattern of holes, or different patterns. Incertain instances, at least one of the layers has apertures while atleast one of the layers does not. In various instances, the laserprocess could be utilized to remove bulk shapes from the implantableadjunct, or a layer of the implantable adjunct. In at least one suchinstance, a line could be formed in a layer along the longitudinal cutline and/or toward the outer perimeter of the implantable adjunct, forexample, to create a stepped effect, especially when such a layer isstacked with and bonded to another layer not having such bulk shapesremoved. In various instances, the laser process can be utilized tocreate a feathering effect along the outer edges of the implantableadjunct and/or along the inner lines discussed above, for example. Forinstance, the laser process can be utilized to reduce the thickness ofthe implantable adjunct along the perimeter, and/or within an openingdefined in the implantable adjunct, from approximately 0.006″ toapproximately 0.002″ to 0.003″, for example. Moreover, the laser processcan be utilized to make any other suitable localized changes to theimplantable adjunct. For instance, the density of the holes in theportions of the adjunct that are captured by the staples can be tuned tosoften the adjunct in those areas. In at least one instance, the holescan be limited to certain zones. For example, stronger, non-hole zonescan be created in the adjunct which are aligned with the staple legswhile weaker, hole-zones are aligned with the staple crowns or bases.The reverse of the above-described example is also possible. Although alaser process can be utilized to modify an implantable adjunct comprisedof film, for example, the laser process could be utilized to modify animplantable adjunct comprised of foam and/or melt-blown non-wovenmaterial, for example. In addition to or in lieu of the laser processdescribed above, water-cutting, stamping, punching and/or piercing, forexample, could be utilized. Also, in addition to or in lieu of the laserprocess described above, an implantable adjunct can undergo a dimplingprocess which can locally stretch the adjunct. The dimples can have athickness that is thinner than the non-dimpled areas of the adjunct. Thedimples can be used in the same or similar manner as the holes toachieve the same or similar results. In various instances, the dimplesand/or holes can be present in any suitable layer of an adjunct. In atleast one instance, the dimples and/or holes are buried, or present inan inner layer, of the adjunct, for example. In certain instances, theselective use of low molecular weight polymers within an adjunctcomprised of high molecular weight polymers can be utilized to createsofter regions within the adjunct. Ultimately, the processes describedabove can be utilized to create a compliant, highly elastic, andstretchable implantable adjunct having a porosity which is sufficient topromote tissue ingrowth.

EXAMPLES Example 1

A method of applying an implantable layer to a cartridge body comprisingthe steps of obtaining a staple cartridge body including staplecavities, heating a polymeric material, and accelerating the heatedpolymeric material toward the staple cartridge body such that animplantable layer is formed over the staple cavities.

Example 2

The method of Example 1, further comprising the step of insertingstaples into the staple cavities before the accelerating step.

Example 3

The method of Examples 1 or 2, further comprising the steps of coolingthe heated polymeric material and trimming the polymeric material afterthe cooling step.

Example 4

The method of Example 3, wherein the cartridge body comprises aperiphery, and wherein the implantable layer is trimmed according to theperiphery during the trimming step.

Example 5

The method of Examples 1, 2, 3, or 4, wherein the heating step comprisesheating the polymeric material above its glass transition temperature.

Example 6

The method of Examples 1, 2, 3, 4, or 5, wherein the heating stepcomprises heating the polymeric material above its melt temperature.

Example 7

The method of Examples 1, 2, 3, 4, 5, or 6, further comprising the stepsof heating a second polymeric material and accelerating the secondheated polymeric material toward the staple cartridge body such that asecond implantable layer is formed over the staple cavities.

Example 8

The method of Examples 1, 2, 3, 4, 5, 6, or 7, wherein the heatedpolymeric material comprises a first heated polymeric material, andwherein the accelerating step comprises accelerating a second heatedpolymeric material with the first heated polymeric material toward thestaple cartridge body.

Example 9

The method of Examples 1, 2, 3, 4, 5, 6, 7, or 8, wherein the method isperformed without mixing the polymeric material with a solvent.

Example 10

The method of Examples 1, 2, 3, 4, 5, 6, 7, 8, or 9, wherein the methodis performed without mixing the polymeric material with dioxane.

Example 11

The method of Examples 1, 2, 3, 4, 5, 6, 7, 8, 9, or 10, wherein theaccelerating step comprises accelerating the polymeric materialutilizing an electric charge.

Example 12

The method of Examples 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, or 11, wherein theaccelerating step comprises accelerating the polymeric materialutilizing a voltage differential.

Example 13

The method of Examples 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, or 12, whereinthe accelerating step comprises accelerating the polymeric materialutilizing a spinning member.

Example 14

The method of Examples 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, or 13,wherein the accelerating step comprises pouring the polymeric materialonto the staple cartridge body utilizing gravity.

Example 15

The method of Examples 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, or 14,wherein the accelerating step comprises the steps of applying atranslational acceleration to the polymeric material and applying arotational acceleration to the polymeric material.

Example 16

The method of Examples 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, or15, wherein the accelerating step comprises creating a random, porouspolymeric structure on the staple cartridge body.

Example 17

The method of Examples 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14,15, or 16, wherein the heating step comprises liquefying the polymericmaterial.

Example 18

The method of Examples 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14,15, or 16, wherein the heating step does not comprise liquefying thepolymeric material.

Example 19

A method of applying an implantable layer to a cartridge body comprisingthe steps of obtaining a staple cartridge body including staplecavities, heating a polymeric material, and applying the heatedpolymeric material directly onto the staple cartridge body such that animplantable layer is formed over the staple cavities.

Example 20

A method of applying an implantable layer to a cartridge body comprisingthe steps of obtaining a staple cartridge body including staplecavities, heating a material, and accelerating the heated materialtoward the staple cartridge body such that an implantable layer isformed over the staple cavities.

Example 21

A staple cartridge assembly comprising a cartridge body comprising adeck, a plurality of staples and an implantable layer positioned overthe deck. The implantable layer comprises a first plurality of fiberscomprised of a first material having a first thermal transitiontemperature and a second plurality of fibers comprised of a secondmaterial having a second thermal transition temperature, wherein thesecond thermal transition temperature is lower than the first thermaltransition temperature, wherein the second material is intermixed withthe first material, and wherein the second fibers are contracted withinthe layer during a process which exposes the layer to a processtemperature which exceeds the second thermal transition temperature.

Example 22

The staple cartridge assembly of Example 21, wherein the secondplurality of fibers are arranged in a structural lattice frame, andwherein the structural lattice frame contracts during the process.

Example 23

The staple cartridge assembly of Examples 21 or 22, wherein the secondmaterial comprises polydioxanone.

Example 24

The staple cartridge assembly of Examples 21, 22, or 23, wherein thefirst material comprises polyglycolic acid.

Example 25

The staple cartridge assembly of Examples 21, 22, 23, or 24, wherein theimplantable layer is part of an implantable layer assembly which furthercomprises a laminate film.

Example 26

The staple cartridge assembly of Examples 21, 22, 23, 24, or 25, whereinthe process temperature is less than the first thermal transitiontemperature.

Example 27

A staple cartridge assembly comprising a cartridge body comprising adeck, a plurality of staples, and an implantable layer positioned overthe deck. The implantable layer comprises a mesh comprised of a firstmaterial having a first thermal transition temperature and fiberscomprised of a second material having a second thermal transitiontemperature, wherein the first thermal transition temperature is lowerthan the second thermal transition temperature, wherein the fibers areinterwoven with the mesh, and wherein the mesh is constricted during aprocess which exposes the layer to a process temperature which exceedsthe first thermal transition temperature.

Example 28

The staple cartridge assembly of Example 27, wherein the first materialcomprises polydioxanone.

Example 29

The staple cartridge assembly of Examples 27 or 28, wherein the secondmaterial comprises polyglycolic acid.

Example 30

The staple cartridge assembly of Examples 27, 28, or 29, wherein theimplantable layer is part of an implantable layer assembly which furthercomprises a laminate film.

Example 31

The staple cartridge assembly of Examples 27, 28, 29, or 30, wherein theprocess temperature is less than the second thermal transitiontemperature.

Example 32

A staple cartridge assembly comprising a cartridge body comprising adeck, a plurality of staples, and an implantable layer positioned overthe deck. The implantable layer comprises a first plurality of fiberscomprised of a first material having a first glass transitiontemperature and a second plurality of fibers comprised of a secondmaterial having a second glass transition temperature, wherein thesecond glass transition temperature is lower than the first glasstransition temperature, wherein the second material is interwoven withthe first material, and wherein the second glass transition temperaturehas been previously exceeded to contract the second fibers.

Example 33

The staple cartridge assembly of Example 32, wherein the first materialcomprises polydioxanone.

Example 34

The staple cartridge assembly of Examples 32 or 33, wherein the secondmaterial comprises polyglycolic acid.

Example 35

The staple cartridge assembly of Examples 32, 33, or 34, wherein theimplantable layer is part of an implantable layer assembly which furthercomprises a laminate film.

Example 36

A method of manufacturing an implantable layer, the method comprisingthe steps of obtaining first fibers comprised of a first material havinga first thermal transition temperature, obtaining second fiberscomprised of a second material having a second thermal transitiontemperature, wherein the second thermal transition temperature is lowerthan the first thermal transition temperature, intermixing the firstfibers with the second fibers, and heating the second fibers to aprocessing temperature which exceeds the second thermal transitiontemperature so that the second fibers contract after the intermixingstep.

Example 37

The method of Example 36, wherein the intermixing step comprisesinterweaving the first fibers and the second fibers.

Example 38

The method of Examples 36 or 37, wherein the processing temperature doesnot exceed the first thermal transition temperature.

Example 39

The method of Examples 36, 37, or 38, wherein the intermixing stepcomprises interweaving the first fibers into a mesh of the secondfibers.

Example 40

A compressible adjunct for use with a surgical instrument, wherein thecompressible adjunct comprises a hollow fibrous construct and a corefibrous construct housed within the hollow fibrous construct, whereinthe hollow fibrous construct comprises at least one biocompatiblematerial that experienced at least one transition from a more orderedphase to a less ordered phase in response to heating the hollow fibrousconstruct to a predetermined temperature.

Example 41

The compressible adjunct of Example 40, wherein the at least onetransition constricts the hollow fibrous construct around the corefibrous construct.

Example 42

The compressible adjunct of Examples 40 or 41, wherein the at least onetransition comprises an increase in entropy.

Example 43

The compressible adjunct of Examples 40, 41, or 42, wherein the at leastone biocompatible material is an elastomer.

Example 44

The compressible adjunct of Examples 40, 41, 42, or 43, wherein the corefibrous construct comprises the at least one biocompatible material.

Example 45

The compressible adjunct of Examples 40, 41, 42, 43, or 44, wherein thehollow fibrous construct is transitioned from a first size to a secondsize smaller than the first size in response to the at least onetransition.

Example 46

The compressible adjunct of Examples 40, 41, 42, 43, 44, or 45, furthercomprising an elongate slot, wherein the elongate slot extends along alength of the hollow fibrous construct, and wherein the elongate slotextends along a length of the core fibrous construct.

Example 47

A compressible adjunct for use with a surgical instrument, thecompressible adjunct comprising a hollow fibrous construct comprising afirst fibrous tubular member defining a space within and a secondfibrous tubular member treated with at least one thermal treatment,wherein the hollow fibrous construct extends at least partially throughthe space.

Example 48

The compressible adjunct of Example 47, wherein the first fibroustubular member is shrunk around the second fibrous tubular member inresponse to the at least one thermal treatment.

Example 49

The compressible adjunct of Examples 47 or 48, wherein the first fibroustubular member comprises at least one biocompatible material thatexperienced at least one transition from a more ordered phase to a lessordered phase in response to the at least one thermal treatment.

Example 50

The compressible adjunct of Examples 47, 48, or 49, wherein the hollowfibrous construct comprises at least one biocompatible material thatexperienced a temporary phase transition in response to the at least onethermal treatment.

Example 51

The compressible adjunct of Examples 49 or 50, wherein the at least onebiocompatible material is an elastomer.

Example 52

The compressible adjunct of Examples 49, 50, or 51, wherein the at leastone biocompatible material is absorbable.

Example 53

The compressible adjunct of Examples 47, 48, 49, 50, 51, or 52, whereinthe hollow fibrous construct comprises a first biocompatible materialthat experienced a temporary phase change in response to the at leastone thermal treatment and a second biocompatible material that remainedin a solid phase during the at least one thermal treatment.

Example 54

The compressible adjunct of Example 47, wherein the hollow fibrousconstruct is transitioned from a first size to a second size smallerthan the first size in response to the at least one thermal treatment.

Example 55

A method for preparing a compressible adjunct for use with a surgicalinstrument, the method comprising providing a first fibrous tubularmember defining a space there within, providing a second fibrous tubularmember sized to fit into the space, inserting the second fibrous tubularmember into the space, and effecting an at least one change in at leastone of the first fibrous tubular member and the second fibrous tubularmember through at least one thermal treatment.

Example 56

The method of Example 55, wherein the effecting step comprises shrinkingthe first fibrous tubular member around the second fibrous tubularmember.

Example 57

The method of Examples 55 or 56, wherein at least one of the firstfibrous tubular member and the second fibrous tubular member comprisesat least one biocompatible material, and wherein the effecting stepcomprises effecting a temporary phase change in the at least onebiocompatible material.

Example 58

The method of Examples 55, 56, or 57, wherein at least one of the firstfibrous tubular member and the second fibrous tubular member comprisesat least one biocompatible material, and wherein the effecting stepcomprises at least one transition in the at least one biocompatiblematerial from a more ordered phase to a less ordered phase.

Example 59

The method of Examples 55, 56, 57, or 58, wherein the effecting stepcomprises at least one change in size in the at least one of the firstfibrous tubular member around the second fibrous tubular member.

Example 60

A staple cartridge assembly comprising a cartridge body comprising adeck, a plurality of staples, and an implantable layer positioned overthe deck, wherein the implantable layer comprises a plurality ofinterwoven fibers, and wherein each fiber comprises a strand having akinked configuration.

Example 61

The staple cartridge assembly of Example 60, wherein the kinkedconfiguration of the fibers is produced by exposing the fibers to heat.

Example 62

The staple cartridge assembly of Examples 60 or 61, wherein the kinkedfibers are interwoven into a first woven zone and a second woven zone,wherein the first woven zone has a first density and the second wovenzone has a second density, and wherein the first density is differentthan the second density.

Example 63

The staple cartridge assembly of Example 62, wherein the implantablelayer comprises a perimeter, wherein the second density is greater thanthe first density, and wherein the second woven zone is defined alongthe perimeter.

Example 64

The staple cartridge assembly of Example 62, wherein the cartridge bodycomprises a longitudinal slot configured to receive a cutting portion,wherein the first density is less than the second density, and whereinthe first woven zone is aligned with the longitudinal slot.

Example 65

The staple cartridge assembly of Examples 62 or 63, further comprisingan anchor extending over the implantable layer to releasably hold thelayer to the cartridge body, wherein the second density is greater thanthe first density, and wherein the anchor is aligned with the secondwoven zone.

Example 66

The staple cartridge assembly of Example 65, wherein the cartridge bodyfurther comprises a longitudinal slot, wherein the longitudinal slot isconfigured to receive a cutting member, and wherein the cutting memberis configured to transect the anchor as the cutting member moves withinthe longitudinal slot.

Example 67

The staple cartridge assembly of Examples 65 or 66, further comprising aproximal end, wherein the anchor and the second woven zone are adjacentthe proximal end.

Example 68

The staple cartridge assembly of Example 67, further comprising a distalend opposite the proximal end, a distal anchor extending over theimplantable layer to releasably hold the layer to the cartridge body,and a third woven zone defined in the layer having a third density whichis greater than the first density, wherein the distal anchor is alignedwith the third woven zone.

Example 69

The staple cartridge assembly of Examples 62, 63, 64, 65, 66, 67, or 68,wherein the cartridge body comprises a first longitudinal row of staplecavities and a second longitudinal row of staple cavities, wherein thefirst woven zone is aligned with the first row of staple cavities andthe second woven zone is aligned with the second row of staple cavities.

Example 70

The staple cartridge assembly of Examples 60, 61, 62, 63, 64, 65, 66,67, 68, or 69, wherein the kinked fibers are interwoven into a firstwoven zone and a second woven zone, wherein the first woven zone has afirst modulus of elasticity and the second woven zone has a secondmodulus of elasticity, and wherein the first modulus of elasticity isdifferent than the second modulus of elasticity.

Example 71

The staple cartridge assembly of Example 70, wherein the implantablelayer comprises a perimeter, wherein the second density is greater thanthe first density, and wherein the second woven zone is defined alongthe perimeter.

Example 72

The staple cartridge assembly of Examples 70 or 71, wherein thecartridge body comprises a longitudinal slot configured to receive acutting portion, wherein the first modulus of elasticity is less thanthe second modulus of elasticity, and wherein the first woven zone isaligned with the longitudinal slot.

Example 73

The staple cartridge assembly of Examples 70 or 71, further comprisingan anchor extending over the implantable layer to releasably hold thelayer to the cartridge body, wherein the second modulus of elasticity isgreater than the first modulus of elasticity, and wherein the anchor isaligned with the second woven zone.

Example 74

The staple cartridge assembly of Example 73, wherein the cartridge bodyfurther comprises a longitudinal slot, wherein the longitudinal slot isconfigured to receive a cutting member, and wherein the cutting memberis configured to transect the anchor as the cutting member moves withinthe longitudinal slot.

Example 75

The staple cartridge assembly of Examples 73 or 74, further comprising aproximal end, wherein the anchor and the second woven zone are adjacentthe proximal end.

Example 76

The staple cartridge assembly of Example 75, further comprising a distalend opposite the proximal end, a distal anchor extending over theimplantable layer to releasably hold the layer to the cartridge body,and a third woven zone defined in the layer having a third modulus ofelasticity which is greater than the first modulus of elasticity,wherein the distal anchor is aligned with the third woven zone.

Example 77

The staple cartridge assembly of Examples 70, 71, 72, 73, 74, 75, or 76,wherein the cartridge body comprises a first longitudinal row of staplecavities and a second longitudinal row of staple cavities, wherein thefirst woven zone is aligned with the first row of staple cavities andthe second woven zone is aligned with the second row of staple cavities.

Example 78

A method of manufacturing an implantable layer, the method comprisingthe steps of obtaining fibers, weaving the fibers, unweaving the fibersafter the weaving step, kinking the fibers after the unweaving step, andreweaving the fibers into an implantable layer after the kinking step.

Example 79

The method of Example 78, wherein the reweaving step comprises knittingthe fibers into a fluffy fabric.

Example 80

A compressible adjunct for use with a surgical instrument including astaple cartridge deck, wherein the compressible adjunct comprises afirst biocompatible material, a second biocompatible material with alower melting temperature than the first biocompatible material, and abody comprising a face positionable against a length of the staplecartridge deck. The face comprises a plurality of attachment regionsspaced apart from one another, wherein the plurality of attachmentregions include the second biocompatible material, and wherein the faceis selectively attachable to the staple cartridge deck at the pluralityof attachment regions. The face further comprises a plurality ofnon-attachment regions extending between the plurality of attachmentregions, wherein the second biocompatible material is selectivelydisposed outside the non-attachment regions.

Example 81

The compressible adjunct of Example 80, wherein the plurality ofattachment regions define an attachment pattern.

Example 82

The compressible adjunct of Examples 80 or 81, wherein the bodycomprises a woven fibrous construct.

Example 83

The compressible adjunct of Examples 80, 81, or 82, wherein at least oneof the first biocompatible material and the second biocompatiblematerial is absorbable.

Example 84

The compressible adjunct of Examples 80, 81, 82, or 83 wherein thesecond biocompatible material is poly-p-dioxanone (PDS).

Example 85

A staple cartridge assembly for use with a surgical stapling instrument,wherein the staple cartridge assembly comprises a staple cartridgecomprising a plurality of staples and a cartridge deck comprising anouter surface. The staple cartridge further comprises a fibrousconstruct comprising, one, a body comprising a first plurality of fiberscomprised of a first biocompatible material having a first meltingtemperature and, two, a face positioned against the outer surface of thecartridge deck. The face comprises a plurality of attachment regionsspaced apart from one another, wherein each of the plurality ofattachment regions comprises a second plurality of fibers comprised of asecond biocompatible material having a second melting temperature lowerthan the first melting temperature and a plurality of non-attachmentregions extending between the plurality of attachment regions, whereinthe non-attachment regions exclude the second plurality of fibers, andwherein the face is selectively attached to the outer surface at theplurality of attachment regions by temporarily heating the face to atemperature greater than or equal to the second melting temperature butless than the first melting temperature.

Example 86

The staple cartridge assembly of Example 85, wherein the plurality ofattachment regions define an attachment pattern.

Example 87

The staple cartridge assembly of Examples 85 or 86, wherein the fibrousconstruct is a woven fibrous construct.

Example 88

The staple cartridge assembly of Examples 85, 86, or 87, wherein atleast one of the first biocompatible material and the secondbiocompatible material is absorbable.

Example 89

The staple cartridge assembly of Examples 85, 86, 87, or 88, wherein thesecond biocompatible material is poly-p-dioxanone (PDS).

Example 90

The staple cartridge assembly of Examples 85, 86, 87, 88, or 89, whereinthe cartridge deck further comprises at least one attachment memberconfigured to secure the fibrous construct to the outer surface.

Example 91

The staple cartridge assembly of Example 90, wherein the at least oneattachment member comprises a mechanical barb.

Example 92

The staple cartridge assembly of Examples 85, 86, 87, 88, 89, 90, or 91,wherein the outer surface comprises a plurality of rough zones.

Example 93

The staple cartridge assembly of Example 92, wherein the rough zones areetched into the outer surface.

Example 94

A staple cartridge assembly for use with a surgical stapling instrument,wherein the staple cartridge assembly comprises a staple cartridgecomprising a plurality of staples and a cartridge deck. The cartridgedeck comprises an outer surface comprising a plurality of attachmentzones spaced apart from one another and a plurality of bonding islands,wherein each of the plurality of bonding islands is disposed within oneof the attachment zones, and wherein each of the plurality of bondingislands is comprised of a first biocompatible material. The staplecartridge assembly further comprises a compressible layer positionedagainst the cartridge deck, wherein the compressible layer is comprisedof a second biocompatible material different from the firstbiocompatible material, and wherein the compressible layer is secured tothe cartridge deck by a temporary phase transition in the firstbiocompatible material.

Example 95

The staple cartridge assembly of Example 94, wherein the temporary phasetransition in the first biocompatible material is not accompanied by aphase transition in the second biocompatible material.

Example 96

The staple cartridge assembly of Examples 94 or 95, wherein thecartridge deck further comprises at least one attachment memberconfigured to secure the compressible layer to the cartridge deck.

Example 97

The staple cartridge assembly of Example 96, wherein the at least oneattachment member comprises a mechanical barb.

Example 98

The staple cartridge assembly of Examples 94, 95, 96, or 97, wherein theattachment zones are etched into the outer surface.

Example 99

A surgical instrument comprising a jaw member comprising an elongateslot extending along a longitudinal axis, a first outer surface on afirst side of the elongate slot, and a second outer surface on a secondside of the elongate slot opposite the first side. The surgicalinstrument further comprises a compressible adjunct assembly comprisingan attachment layer comprising a first section on the first side of theelongate slot, wherein the first section is attached to the first outersurface, a second section on the second side of the elongate slot,wherein the second section is attached to the second outer surface, andan intermediary section extending between the first section and thesecond section, wherein the intermediary section at least partiallybridges the elongate slot. The compressible adjunct assembly furthercomprises a first compressible adjunct on the first side of the elongateslot, and a second compressible adjunct on the second side of theelongate slot, wherein the first compressible adjunct is spaced apartfrom the second compressible adjunct, wherein the first section isattached to the first compressible adjunct, and wherein the secondsection is attached to the second compressible adjunct.

Example 100

The surgical instrument of Example 99, wherein the intermediary sectioncomprises a bar extending along a length of the intermediary section,wherein the bar is stepped up from the first section, and wherein thebar is stepped up from the second section.

Example 101

The surgical instrument of Example 100, wherein the bar is alignedlongitudinally with the elongate slot.

Example 102

The surgical instrument of Examples 100 or 101, wherein the barprotrudes into a gap defined between the first compressible adjunct andthe second compressible adjunct.

Example 103

The surgical instrument of Examples 100, 101, or 102 wherein the barprotrudes into the elongate slot.

Example 104

The surgical instrument of Examples 99, 100, 101, 102, or 103, whereinthe intermediary section comprises at least one anchoring feature forsecuring the compressible adjunct assembly to the jaw member.

Example 105

The surgical instrument of Examples 99, 100, 101, 102, 103, or 104,wherein the intermediary section comprises a plurality of projectionsspaced apart from one another.

Example 106

The surgical instrument of Example 105, wherein the projections arealigned longitudinally with the elongate slot.

Example 107

The surgical instrument of Examples 105 or 106, wherein the projectionsprotrude into a gap defined between the first compressible adjunct andthe second compressible adjunct.

Example 108

The surgical instrument of Examples 105, 106, or 107, wherein theprojections protrude into the elongate slot.

Example 109

The surgical instrument of Examples 100, 101, 102, 103, 104, 105, 106,107, or 108, wherein the attachment layer comprises a film.

Example 110

The surgical instrument of Examples 100, 101, 102, 103, 104, 105, 106,107, 108, or 109, wherein the attachment layer is thinner than the firstcompressible adjunct, and wherein the attachment layer is thinner thanthe second compressible adjunct.

Example 111

The surgical instrument of Examples 100, 101, 102, 103, 104, 105, 106,107, 108, 109, or 110, wherein the first section completely separatesthe first compressible adjunct from the first outer surface, and whereinthe second section completely separates the second compressible adjunctfrom the second outer surface.

Example 112

The surgical instrument of Examples 100, 101, 102, 103, 104, 105, 106,107, 108, 109, 110, or 111, wherein the first compressible adjunctextends laterally beyond the first section in a first direction awayfrom the elongate slot, and wherein the first outer surface extendslaterally beyond the first section in the first direction.

Example 113

The surgical instrument of Example 112, wherein the second compressibleadjunct extends laterally beyond the second section in a seconddirection away from the elongate slot, wherein the second outer surfaceextends laterally beyond the second compressible adjunct in the seconddirection, and wherein the second direction is opposite the firstdirection.

Example 114

The surgical instrument of Examples 100, 101, 102, 103, 104, 105, 106,107, 108, 109, 110, 111, 112, or 113, wherein the first outer surfacecomprises a first plurality of pockets, wherein the second outer surfacecomprises a second plurality of pockets, wherein the attachment layer ispositioned between the first plurality of pockets and the secondplurality of pockets.

Example 115

A surgical instrument comprising a jaw member comprising an elongateslot extending along a longitudinal axis, a first outer surface on afirst side of the elongate slot, and a second outer surface on a secondside of the elongate slot opposite the first side. The surgicalinstrument further comprises a compressible adjunct assembly comprisinga compressible layer comprising a first compressible portion on thefirst side of the elongate slot, a second compressible portion on thesecond side of the elongate slot, and a first plurality of bridgingportions separated by a plurality of gaps, wherein the first pluralityof bridging portions extend between the first compressible portion andthe second compressible portion, wherein the first plurality of bridgingportions are arranged along a length of the elongate slot, and whereineach of the first plurality of bridging portions bridges the elongateslot. The compressible adjunct assembly further comprises an attachmentlayer comprising a first attachment portion on the first side of theelongate slot, wherein the first attachment portion is attached to thefirst outer surface, and wherein the first attachment portion isattached to the first compressible portion, and a second attachmentportion on the second side of the elongate slot, wherein the secondattachment portion is attached to the second outer surface, and whereinthe second attachment portion is attached to the second compressibleportion. The attachment layer further comprises a second plurality ofbridging portions separated by the plurality of gaps, wherein the secondplurality of bridging portions extend between the first attachmentportion and the second attachment portion, wherein the second pluralityof bridging portions are arranged along the length of the elongate slot,and wherein each of the second plurality of bridging portions bridgesthe elongate slot.

Example 116

The surgical instrument of Example 115, wherein the attachment layercomprises a film.

Example 117

The surgical instrument of Examples 115 or 116, wherein the attachmentlayer is thinner than the compressible layer.

Example 118

A surgical instrument comprising an anvil comprising an elongate slotextending along a longitudinal axis, an internal surface defining aninternal gap connected to the elongate slot, a first outer surface on afirst side of the elongate slot, and a second outer surface on a secondside of the elongate slot opposite the first side. The surgicalinstrument further comprises a compressible adjunct assembly comprisinga compressible layer comprising a first compressible portion on thefirst side of the elongate slot a second compressible portion on thesecond side of the elongate slot, and an intermediate compressibleportion extending between the first compressible portion and the secondcompressible portion, wherein the intermediate compressible portionbridges the slot. The compressible adjunct assembly further comprises atleast one attachment member comprising a first attachment portionpositioned against the internal surface, a second attachment portionattached to the intermediate compressible portion, and a couplingportion connecting the first attachment portion to the second attachmentportion.

Example 119

The surgical instrument of Example 118, wherein the coupling portionextends into the elongate slot.

Example 120

The surgical instrument of Examples 118 or 119, wherein the secondattachment portion is embedded in the intermediate compressible portion.

Example 121

A staple cartridge assembly for use with a surgical stapling instrument,wherein the staple cartridge assembly is configured to receive a firingactuation such that, upon receiving the firing actuation, a firingassembly is configured to translate through the staple cartridgeassembly from a proximal end to a distal end during a firingprogression, and wherein the staple cartridge assembly comprises acartridge body, a plurality of staples removably stored within thecartridge body, and an implantable adjunct. The implantable adjunctcomprises a body portion and a plurality of distinct attachment portionsconfigured to retain the implantable adjunct against the cartridge body,wherein the firing assembly is configured to engage each attachmentportion during the firing progression, and wherein the attachmentportions are progressively released from the cartridge body during theadvancement of the firing assembly from the proximal end to the distalend.

Example 122

The staple cartridge assembly of Example 121, wherein each staple isconfigured to separate each attachment portion from the cartridge body.

Example 123

The staple cartridge assembly of Examples 121 or 122, wherein the firingassembly is configured to lift the implantable adjunct away from thecartridge body to release the implantable adjunct from the cartridgebody.

Example 124

The staple cartridge assembly of Examples 121, 122, or 123, furthercomprising a plurality of drivers, wherein the cartridge body comprisesa deck surface, wherein the firing assembly is configured to lift thedrivers above the deck surface.

Example 125

The staple cartridge assembly of Examples 121, 122, 123, or 124, whereinthe cartridge body comprises a plurality of staple cavities, and whereinthe attachment portions extend at least partially into the staplecavities.

Example 126

The staple cartridge assembly of Examples 121, 122, 123, 124, or 125,wherein the implantable adjunct comprises a unitary piece of material.

Example 127

The staple cartridge assembly of Examples 121, 122, 123, 124, 125, or126, wherein the cartridge body comprises a slot, wherein the attachmentportions are positioned adjacent the slot, and wherein the firingassembly comprises a release portion configured to engage the attachmentportions to release the implantable adjunct from the cartridge body asthe firing assembly advances from the proximal end to the distal end.

Example 128

The staple cartridge assembly of Examples 121, 122, 123, 124, 125, 126,or 127, wherein the implantable adjunct comprises a first portion andsecond portion wherein the first portion is configured to be detachedfrom the second portion, and wherein the second portion is configured tobe retained against the cartridge body by a staple that has not beendeployed by the firing assembly.

Example 129

The staple cartridge assembly of Examples 121, 122, 123, 124, 125, 126,127, or 128, wherein the implantable adjunct further comprises adiscontinuity, and wherein the first portion is detachable from thesecond portion at the discontinuity.

Example 130

The staple cartridge assembly of Example 129, wherein the discontinuitycomprises at least one perforation.

Example 131

The staple cartridge assembly of Examples 121, 122, 123, 124, 125, 126,127, 128, 129, or 130 wherein each staple comprises a pair of staplelegs, and wherein each staple leg comprises a barb embedded in theimplantable adjunct.

Example 132

The staple cartridge assembly of Example 131, wherein the barbs extendoutwardly.

Example 133

The staple cartridge assembly of Examples 121, 122, 123, 124, 125, 126,127, 128, 129, 130, 131, or 132, wherein the cartridge body comprises aplurality of staple cavities, and wherein each attachment portionextends over a staple cavity.

Example 134

The staple cartridge assembly of Examples 121, 122, 123, 124, 125, 126,127, 128, 129, 130, 131, 132, or 133, wherein the staples engage theattachment portions and detach the attachment portions from thecartridge body when the staples are ejected from the cartridge body.

Example 135

A staple cartridge assembly comprising a cartridge body comprising aproximal end, a distal end, a deck, a plurality of staple cavitiesdefined in the deck, and a longitudinal slot defined in the deckextending from the proximal end toward the distal end. The staplecartridge assembly further comprises a plurality of staples removablystored within the staple cavities, a firing member configured to ejectthe staples from the staple cavities during a firing progression of thefiring member from the proximal end toward the distal end, and animplantable adjunct. The implantable adjunct comprises a body portionand a plurality of distinct attachment portions configured to releasablyretain the implantable adjunct against the cartridge body, wherein thefiring member is configured to progressively release the attachmentportions from the cartridge body during the firing progression.

Example 136

The staple cartridge assembly of Example 135, wherein the firing memberextends over the deck and directly engages the attachment portions.

Example 137

The staple cartridge assembly of Examples 135 or 136, wherein the staplecavities are arranged in longitudinal rows, wherein the longitudinalrows comprise inner longitudinal rows adjacent the longitudinal slot,and wherein the attachment portions are positioned intermediate thelongitudinal slot and the inner longitudinal rows.

Example 138

The staple cartridge assembly of Example 137, wherein the firing memberslides along the deck between the longitudinal slot and the innerlongitudinal rows.

Example 139

A method for assembling a surgical stapling assembly for use with asurgical stapling instrument, the surgical stapling assembly comprisinga staple cartridge, a plurality of staples, and a fibrous adjunctpositioned at least partially on the staple cartridge, the methodcomprising pouring fibrous adjunct material onto a mold resembling thestaple cartridge, allowing the fibrous adjunct material to cool,removing the fibrous adjunct material from the mold, and placing thefibrous adjunct material onto the staple cartridge, wherein the fibrousadjunct material maintains a continuous, fibrous structure upon beingplaced onto the staple cartridge.

Example 140

A staple cartridge assembly comprising a cartridge body comprising adeck, staples removably stored in the cartridge body, and an implantableadjunct positioned over the deck. The implantable adjunct comprises afirst outer layer comprised of interwoven fibers, a second outer layercomprised of interwoven fibers, and a bonding layer positionedintermediate the first outer layer and the second outer layer, whereinthe bonding layer is comprised of a meltable material having a thresholdmelt temperature, and wherein the adjunct has previously been exposed toa temperature in excess of the threshold melt temperature such that thebonding layer is bonded with the first outer layer and the second outerlayer.

Example 141

The staple cartridge assembly of Example 140, wherein the interwovenfibers of the first outer layer are comprised of a first material havinga first melt temperature which is greater than the threshold melttemperature, and wherein the interwoven fibers of the first outer layerhave not been melted.

Example 142

The staple cartridge assembly of Example 141, wherein the interwovenfibers of the second outer layer are comprised of a second materialhaving a second melt temperature which is different than the first melttemperature and greater than the threshold melt temperature, and whereinthe interwoven fibers of the second outer layer have not been melted.

Example 143

The staple cartridge assembly of Examples 140, 141, or 142, wherein thebonding layer comprises a first bonding layer, and wherein the adjunctfurther comprises a spacer layer comprised of a material having a melttemperature which is greater than the threshold melt temperature and asecond bonding layer comprised of the meltable material, wherein thefirst bonding layer is positioned intermediate the first outer layer andthe spacer layer, and wherein the second bonding layer is positionedintermediate the second outer layer and the spacer layer.

Example 144

The staple cartridge assembly of Example 143, wherein the spacer layercomprises a plurality of openings defined therein which are configuredto receive melted portions of the first bonding layer and the secondbonding layer when the adjunct is exposed to a temperature in excess ofthe threshold melt temperature.

Example 145

The staple cartridge assembly of Examples 143 or 144, wherein meltedportions of the first bonding layer has penetrated the first outsidelayer, and wherein melted portions of the second bonding layer haspenetrated the second outside layer.

Example 146

The staple cartridge assembly of Examples 143, 144, or 145, wherein theplurality of openings are arranged in a first density in a first portionof the spacer layer and a second density in a second portion of thespacer layer, wherein the first density is greater than the seconddensity, and wherein the bond between the first portion and the bondinglayers is stronger than the bond between the second portion and thebonding layers.

Example 147

The staple cartridge assembly of Examples 143, 144, 145, or 146, whereinthe spacer layer comprises a lofted weave.

Example 148

The staple cartridge assembly of Examples 140, 141, 142, 143, 144, 145,146, or 147, wherein the bonding layer comprises a PDS film.

Example 149

The staple cartridge assembly of Examples 140, 141, 142, 143, 144, 145,146, 147, or 148, wherein the bonding layer comprises apertures definedtherein.

Example 150

The staple cartridge assembly of Examples 140, 141, 142, 143, 144, 145,146, 147, 148, or 149, wherein the bonding layer has penetrated thefirst outside layer and the second outside layer.

Example 151

The staple cartridge assembly of Examples 140, 141, 142, 143, 144, 145,146, 147, 148, 149, or 150, wherein the first outside layer and thesecond outside layer include meltable portions which are comprised ofthe meltable material, and wherein the meltable portions of the firstoutside layer and the second outside layer are merged with the bondinglayer after the adjunct is exposed to a temperature in excess of thethreshold melt temperature.

Example 152

A staple cartridge assembly comprising a cartridge body comprising adeck, staples removably stored in the cartridge body, and an implantablelayer assembly positioned over the deck. The implantable layer comprisesa first layer, a second layer, and a bonding layer positionedintermediate the first layer and the second layer, wherein the bondinglayer is comprised of a meltable material having a threshold melttemperature, and wherein the implantable layer assembly has beenpreviously exposed to a temperature at least equaling the threshold melttemperature such that the bonding layer is bonded with at least one ofthe first layer and the second layer.

Example 153

The staple cartridge assembly of Example 152, wherein the bonding layeris mechanically bonded to the first layer and the second layer.

Example 154

The staple cartridge assembly of Examples 152 or 153, wherein theinterwoven fibers of the first layer are comprised of a first materialhaving a first melt temperature which is greater than the threshold melttemperature, and wherein the interwoven fibers of the first layer havenot been melted.

Example 155

The staple cartridge assembly of Example 154, wherein the interwovenfibers of the second layer are comprised of a second material having asecond melt temperature which is different than the first melttemperature and greater than the threshold melt temperature, and whereinthe interwoven fibers of the second layer have not been melted.

Example 156

The staple cartridge assembly of Examples 152, 153, 154, or 155, whereinthe bonding layer comprises a first bonding layer, and wherein theimplantable layer assembly further comprises a spacer layer comprised ofa material having a melt temperature which is greater than the thresholdmelt temperature and a second bonding layer comprised of the meltablematerial, wherein the first bonding layer is positioned intermediate thefirst layer and the spacer layer, and wherein the second bonding layeris positioned intermediate the second layer and the spacer layer.

Example 157

The staple cartridge assembly of Example 156, wherein the spacer layercomprises a plurality of openings defined therein which are configuredto receive melted portions of the first bonding layer and the secondbonding layer when the adjunct is exposed to a temperature that at leastequals the threshold melt temperature.

Example 158

The staple cartridge assembly of Example 157, wherein the plurality ofopenings are arranged in a first density in a first portion of thespacer layer and a second density in a second portion of the spacerlayer, wherein the first density is greater than the second density, andwherein a bond between the first portion and the bonding layers isstronger than a bond between the second portion and the bonding layers.

Example 159

The staple cartridge assembly of Examples 156, 157, or 158, whereinmelted portions of the first bonding layer has penetrated the firstlayer, and wherein melted portions of the second bonding layer haspenetrated the second layer.

Example 160

A method of manufacturing a staple cartridge assembly comprising thesteps of obtaining a first layer, a second layer, and a bonding layer,positioning the bonding layer intermediate the first layer and thesecond layer, heating the bonding layer to a temperature which at leastpartially melts the bonding layer, obtaining a cartridge body,positioning staples in the cartridge body, and attaching the firstlayer, the second layer, and the bonding layer to the cartridge body.

Example 161

The method of Example 160, wherein the heating step does not melt thefirst layer and the second layer.

Example 162

A staple cartridge assembly for use with a surgical stapler, wherein thestaple cartridge assembly comprises a staple cartridge comprising acartridge body, a cartridge deck, and a plurality of staples deployablefrom the cartridge body through the cartridge deck. The staple cartridgeassembly further comprises a compressible adjunct positionable againstthe cartridge deck, wherein the compressible adjunct comprises aplurality of unaltered fibers comprising a first fiber including a firstfiber portion and a second fiber including a second fiber portionextending over the first fiber portion. The compressible adjunct furthercomprises a plurality of altered fibers that are melted and resolidifiedand a node comprising the first fiber portion, the second fiber portion,and at least a portion of the plurality of altered fibers, wherein theat least a portion of the plurality of altered fibers affixes the firstfiber portion and the second fiber portion.

Example 163

The staple cartridge assembly of Example 162, wherein the first fiberand the second fiber are comprised of a first biocompatible materialcomprising a first melting point.

Example 164

The staple cartridge assembly of Example 163, wherein the plurality ofaltered fibers comprises a second biocompatible material comprising asecond melting point lower than the first melting point.

Example 165

The staple cartridge assembly of Example 164, wherein the first fiber isat least partially covered with the second biocompatible material.

Example 166

The staple cartridge assembly of Examples 162, 163, 164, or 165, whereinthe plurality of unaltered fibers further comprises a third fiberincluding a third fiber portion extending over the first fiber portion.

Example 167

The staple cartridge assembly of Examples 162, 163, 164, 165, or 166,wherein the node releasably attaches the compressible adjunct to thecartridge deck.

Example 168

The staple cartridge assembly of Examples 162, 163, 164, 165, 166, or167, further comprising a plurality of nodes defining attachment zones.

Example 169

The staple cartridge assembly of Example 168, further comprisingunattached zones between the attachment zones.

Example 170

The staple cartridge assembly of Example 169, wherein the attachmentzones comprise greater densities than the unattached zones.

Example 171

A staple cartridge assembly for use with a surgical stapler, wherein thestaple cartridge assembly comprises a staple cartridge comprising acartridge body, a cartridge deck, and a plurality of staples deployablefrom the cartridge body through the cartridge deck. The staple cartridgeassembly further comprises a compressible adjunct positionable againstthe cartridge deck, wherein the compressible adjunct comprises aplurality of unaltered fibers comprising a first fiber including a firstfiber portion and a second fiber including a second fiber portionextending over the first fiber portion. The compressible adjunct furthercomprises a plurality of altered fibers melted and resolidified todefine a bonding medium and a node comprising the first fiber portion,the second fiber portion, and at least a portion of the bonding mediumat least partially surrounding the first fiber portion and the secondfiber portion.

Example 172

The staple cartridge assembly of Example 171, wherein the first fiberand the second fiber are comprised of a first biocompatible materialcomprising a first melting point.

Example 173

The staple cartridge assembly of Example 172, wherein the plurality ofaltered fibers comprises a second biocompatible material comprising asecond melting point lower than the first melting point.

Example 174

The staple cartridge assembly of Example 173, wherein the first fiber isat least partially covered with the second biocompatible material.

Example 175

The staple cartridge assembly of Examples 171, 172, 173, or 174, whereinthe plurality of unaltered fibers further comprises a third fiberincluding a third fiber portion extending over the first fiber portion.

Example 176

The staple cartridge assembly of Examples 171, 172, 173, 174, or 175,wherein the node releasably attaches the compressible adjunct to thecartridge deck.

Example 177

The staple cartridge assembly of Examples 171, 172, 173, 174, 175, or176, further comprising a plurality of nodes defining attachment zones.

Example 178

The staple cartridge assembly of Example 177, further comprisingnon-attachment zones between the attachment zones.

Example 179

The staple cartridge assembly of Example 178, wherein the attachmentzones comprise greater densities than the non-attachment zones.

Example 180

A staple cartridge assembly for use with a surgical stapler, wherein thestaple cartridge assembly comprises a staple cartridge comprising acartridge body, a cartridge deck, and a plurality of staples deployablefrom the cartridge body through the cartridge deck. The staple cartridgeassembly further comprises a compressible adjunct positionable againstthe cartridge deck, wherein the compressible adjunct comprises aplurality of fibers comprising a first fiber including a first fiberportion and a second fiber including a second fiber portion spaced apartfrom the first fiber portion. The compressible adjunct further comprisesa bonding fiber melted and resolidified, wherein the bonding fibercomprises a bonding fiber portion extending between the first fiberportion and the second fiber portion, wherein the bonding fiber portionis attached to the first fiber portion, and wherein the bonding fiberportion is attached to second fiber portion.

Example 181

The staple cartridge assembly of Example 180, wherein the first fiberand the second fiber are comprised of a first biocompatible materialcomprising a first melting point, and wherein the bonding fibercomprises a second biocompatible material comprising a second meltingpoint lower than the first melting point.

Various embodiments are disclosed including adjuncts attached to and/orpositioned on a staple cartridge. It should be understood that suchteachings are applicable to embodiments in which an adjunct is attachedto and/or positioned on an anvil of a surgical instrument. In fact,embodiments are envisioned in which a first adjunct is attached toand/or positioned on a cartridge and a second adjunct is attached toand/or positioned on an anvil.

The compressible adjuncts of the present disclosure can be positionedagainst a cartridge deck of a staple cartridge such as, for example, thecartridge deck 16 of the staple cartridge 12. In at least one instance,a compressible adjunct can be positioned against a cartridge deck of astaple cartridge prior to loading the staple cartridge onto a surgicalinstrument such as, for example, the surgical stapling and severinginstrument 8010 (FIG. 1). Alternatively, a compressible adjunct can bepositioned against a cartridge deck of a staple cartridge after thestaple cartridge has been loaded into the surgical stapling and severinginstrument. A loading unit can be employed to deposit a compressibleadjunct onto the cartridge deck of the staple cartridge. The loadingunit may include various attachment features and/or placement featuresfor manipulating and positioning the compressible adjunct against thecartridge deck. Once the compressible adjunct is correctly positionedagainst the cartridge deck, the loading unit can release thecompressible adjunct.

Further to the above, a compressible adjunct can be positioned against acartridge deck without attachment to the staple cartridge.Alternatively, a compressible adjunct can be attached to the staplecartridge prior to or after the staple cartridge is loaded into thesurgical stapling and severing instrument. For example, the compressibleadjunct can be partially melted onto the cartridge deck thenresolidified by cooling which causes the compressible adjunct to bond tothe cartridge deck. Various attachment features can also be employed toattach a compressible adjunct to a staple cartridge such as, forexample, sutures, straps, barbs, and/or other mechanical attachmentmechanisms.

The entire disclosures of:

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U.S. patent application Ser. No. 12/031,873, entitled END EFFECTORS FORA SURGICAL CUTTING AND STAPLING INSTRUMENT, filed Feb. 15, 2008, nowU.S. Pat. No. 7,980,443;

U.S. patent application Ser. No. 12/235,782, entitled MOTOR-DRIVENSURGICAL CUTTING INSTRUMENT, now U.S. Pat. No. 8,210,411;

U.S. patent application Ser. No. 12/249,117, entitled POWERED SURGICALCUTTING AND STAPLING APPARATUS WITH MANUALLY RETRACTABLE FIRING SYSTEM,now U.S. Pat. No. 8,608,045;

U.S. patent application Ser. No. 12/647,100, entitled MOTOR-DRIVENSURGICAL CUTTING INSTRUMENT WITH ELECTRIC ACTUATOR DIRECTIONAL CONTROLASSEMBLY, filed Dec. 24, 2009; now U.S. Pat. No. 8,220,688;

U.S. patent application Ser. No. 12/893,461, entitled STAPLE CARTRIDGE,filed Sep. 29, 2012, now U.S. Pat. No. 8,733,613;

U.S. patent application Ser. No. 13/036,647, entitled SURGICAL STAPLINGINSTRUMENT, filed Feb. 28, 2011, now U.S. Pat. No. 8,561,870;

U.S. patent application Ser. No. 13/118,241, entitled SURGICAL STAPLINGINSTRUMENTS WITH ROTATABLE STAPLE DEPLOYMENT ARRANGEMENTS, now U.S. Pat.No. 9,072,535;

U.S. patent application Ser. No. 13/524,049, entitled ARTICULATABLESURGICAL INSTRUMENT COMPRISING A FIRING DRIVE, filed on Jun. 15, 2012;now U.S. Pat. No. 9,101,358;

U.S. patent application Ser. No. 13/800,025, entitled STAPLE CARTRIDGETISSUE THICKNESS SENSOR SYSTEM, filed on Mar. 13, 2013, now U.S. PatentApplication Publication No. 2014/0263551;

U.S. patent application Ser. No. 13/800,067, entitled STAPLE CARTRIDGETISSUE THICKNESS SENSOR SYSTEM, filed on Mar. 13, 2013, now U.S. PatentApplication Publication No. 2014/0263552;

U.S. Patent Application Publication No. 2007/0175955, entitled SURGICALCUTTING AND FASTENING INSTRUMENT WITH CLOSURE TRIGGER LOCKING MECHANISM,filed Jan. 31, 2006; and

U.S. Patent Application Publication No. 2010/0264194, entitled SURGICALSTAPLING INSTRUMENT WITH AN ARTICULATABLE END EFFECTOR, filed Apr. 22,2010, now U.S. Pat. No. 8,308,040, are hereby incorporated by referenceherein.

Although the various embodiments of the devices have been describedherein in connection with certain disclosed embodiments, manymodifications and variations to those embodiments may be implemented.Also, where materials are disclosed for certain components, othermaterials may be used. Furthermore, according to various embodiments, asingle component may be replaced by multiple components, and multiplecomponents may be replaced by a single component, to perform a givenfunction or functions. The foregoing description and following claimsare intended to cover all such modification and variations.

The devices disclosed herein can be designed to be disposed of after asingle use, or they can be designed to be used multiple times. In eithercase, however, the device can be reconditioned for reuse after at leastone use. Reconditioning can include any combination of the steps ofdisassembly of the device, followed by cleaning or replacement ofparticular pieces, and subsequent reassembly. In particular, the devicecan be disassembled, and any number of the particular pieces or parts ofthe device can be selectively replaced or removed in any combination.Upon cleaning and/or replacement of particular parts, the device can bereassembled for subsequent use either at a reconditioning facility, orby a surgical team immediately prior to a surgical procedure. Thoseskilled in the art will appreciate that reconditioning of a device canutilize a variety of techniques for disassembly, cleaning/replacement,and reassembly. Use of such techniques, and the resulting reconditioneddevice, are all within the scope of the present application.

By way of example only, aspects described herein may be processed beforesurgery. First, a new or used instrument may be obtained and whennecessary cleaned. The instrument may then be sterilized. In onesterilization technique, the instrument is placed in a closed and sealedcontainer, such as a plastic or TYVEK bag. The container and instrumentmay then be placed in a field of radiation that can penetrate thecontainer, such as gamma radiation, x-rays, or high-energy electrons.The radiation may kill bacteria on the instrument and in the container.The sterilized instrument may then be stored in the sterile container.The sealed container may keep the instrument sterile until it is openedin a medical facility. A device also may be sterilized using any othertechnique known in the art, including but not limited to beta or gammaradiation, ethylene oxide, plasma peroxide, or steam.

While this invention has been described as having exemplary designs, thepresent invention may be further modified within the spirit and scope ofthe disclosure. This application is therefore intended to cover anyvariations, uses, or adaptations of the invention using its generalprinciples.

Any patent, publication, or other disclosure material, in whole or inpart, that is said to be incorporated by reference herein isincorporated herein only to the extent that the incorporated materialsdoes not conflict with existing definitions, statements, or otherdisclosure material set forth in this disclosure. As such, and to theextent necessary, the disclosure as explicitly set forth hereinsupersedes any conflicting material incorporated herein by reference.Any material, or portion thereof, that is said to be incorporated byreference herein, but which conflicts with existing definitions,statements, or other disclosure material set forth herein will only beincorporated to the extent that no conflict arises between thatincorporated material and the existing disclosure material.

What is claimed is:
 1. A staple cartridge assembly for use with asurgical stapler, wherein said staple cartridge assembly comprises: astaple cartridge, comprising: a cartridge body; a cartridge deck; and aplurality of staples deployable from said cartridge body through saidcartridge deck; and a compressible adjunct positionable against saidcartridge deck, wherein said compressible adjunct comprises: a pluralityof unaltered fibers, comprising: a first fiber including a first fiberportion; and a second fiber including a second fiber portion extendingover said first fiber portion; a plurality of altered fibers that aremelted and resolidified; and a node, comprising: said first fiberportion; said second fiber portion; and at least a portion of saidplurality of altered fibers, wherein said at least a portion of saidplurality of altered fibers affixes said first fiber portion and saidsecond fiber portion.
 2. The staple cartridge assembly of claim 1,wherein said first fiber and said second fiber are comprised of a firstbiocompatible material comprising a first melting point.
 3. The staplecartridge assembly of claim 2, wherein said plurality of altered fiberscomprises a second biocompatible material comprising a second meltingpoint lower than said first melting point.
 4. The staple cartridgeassembly of claim 3, wherein said first fiber is at least partiallycovered with said second biocompatible material.
 5. The staple cartridgeassembly of claim 1, wherein said plurality of unaltered fibers furthercomprises a third fiber including a third fiber portion extending oversaid first fiber portion.
 6. The staple cartridge assembly of claim 1,wherein said node releasably attaches said compressible adjunct to saidcartridge deck.
 7. The staple cartridge assembly of claim 1, furthercomprising a plurality of nodes defining attachment zones.
 8. The staplecartridge assembly of claim 7, further comprising unattached zonesbetween said attachment zones.
 9. The staple cartridge assembly of claim8, wherein said attachment zones comprise greater densities than saidunattached zones.
 10. A staple cartridge assembly for use with asurgical stapler, wherein said staple cartridge assembly comprises: astaple cartridge, comprising: a cartridge body; a cartridge deck; and aplurality of staples deployable from said cartridge body through saidcartridge deck; and a compressible adjunct positionable against saidcartridge deck, wherein said compressible adjunct comprises: a pluralityof unaltered fibers, comprising: a first fiber including a first fiberportion; and a second fiber including a second fiber portion extendingover said first fiber portion; a plurality of altered fibers melted andresolidified to define a bonding medium; and a node, comprising: saidfirst fiber portion; said second fiber portion; and at least a portionof said bonding medium at least partially surrounding said first fiberportion and said second fiber portion.
 11. The staple cartridge assemblyof claim 10, wherein said first fiber and said second fiber arecomprised of a first biocompatible material comprising a first meltingpoint.
 12. The staple cartridge assembly of claim 11, wherein saidplurality of altered fibers comprises a second biocompatible materialcomprising a second melting point lower than said first melting point.13. The staple cartridge assembly of claim 12, wherein said first fiberis at least partially covered with said second biocompatible material.14. The staple cartridge assembly of claim 10, wherein said plurality ofunaltered fibers further comprises a third fiber including a third fiberportion extending over said first fiber portion.
 15. The staplecartridge assembly of claim 10, wherein said node releasably attachessaid compressible adjunct to said cartridge deck.
 16. The staplecartridge assembly of claim 10, further comprising a plurality of nodesdefining attachment zones.
 17. The staple cartridge assembly of claim16, further comprising non-attachment zones between said attachmentzones.
 18. The staple cartridge assembly of claim 17, wherein saidattachment zones comprise greater densities than said non-attachmentzones.
 19. A staple cartridge assembly for use with a surgical stapler,wherein said staple cartridge assembly comprises: a staple cartridge,comprising: a cartridge body; a cartridge deck; and a plurality ofstaples deployable from said cartridge body through said cartridge deck;and a compressible adjunct positionable against said cartridge deck,wherein said compressible adjunct comprises: a plurality of fibers,comprising: a first fiber including a first fiber portion; and a secondfiber including a second fiber portion spaced apart from said firstfiber portion; and a bonding fiber melted and resolidified, wherein saidbonding fiber comprises a bonding fiber portion extending between saidfirst fiber portion and said second fiber portion, wherein said bondingfiber portion is attached to said first fiber portion, and wherein saidbonding fiber portion is attached to said second fiber portion.
 20. Thestaple cartridge assembly of claim 19, wherein said first fiber and saidsecond fiber are comprised of a first biocompatible material comprisinga first melting point, and wherein said bonding fiber comprises a secondbiocompatible material comprising a second melting point lower than saidfirst melting point.